Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | L6259 | TX |
NPI | 1043274756 |
---|---|
Provider Name | Anthony David Amoroso |
First Address | College Station, TX 77845-3803 |
Second Address | Bryan, TX 77802-2544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 17/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162698803 | (05) | TX |
H80742 | (02) | TX |