Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 254959 | NY |
N | 207Q00000X | Family Doctor | 4301-046132 | MI |
N | 207Q00000X | Family Doctor | E3023 | AR |
N | 207Q00000X | Family Doctor | J8093 | TX |
N | 207QA0401X | Family Doctor - Addiction Medicine | J8093 | TX |
NPI | 1912022799 |
---|---|
Provider Name | Andrew W Prychodko |
First Address | Lewisville, TX 75029 |
Second Address | Euless, TX 76039-7400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 06/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E50137 | (02) | AR |
E50137 | (02) | TX |