Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R8114 | TX |
Y | 2080P0204X | Pediatric Emergency Doctor | R8114 | TX |
NPI | 1104203769 |
---|---|
Provider Name | Amit Srivastava |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76502-1814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 10/08/2021 |