Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | N6486 | TX |
NPI | 1427291574 |
---|---|
Provider Name | Baher Boutros Maximos |
First Address | Houston, TX 77219-0455 |
Second Address | Houston, TX 77019-2000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2009 |
Last Update Date | 19/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1275962037 | GROUP TAX ID (01) | TX |