Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6135 | TX |
NPI | 1104910207 |
---|---|
Provider Name | Arnulfo Bolado Valle |
First Address | Brownsville, TX 78520 |
Second Address | Brownsville, TX 78520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T16386 | (02) |