Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 19542 | TX |
NPI | 1730296807 |
---|---|
Provider Name | Anne Jones |
First Address | San Antonio, TX 78229 |
Second Address | San Antonio, TX 78229-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 16/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042628001 | (05) | TX |
042628002 | CSHCN (01) | TX |
220022833 | MEDICARE RAILROAD (01) | TX |
U11235 | (02) | TX |