Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | L1635 | TX |
NPI | 1164513800 |
---|---|
Provider Name | Benedict S. Konzen |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 21/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045670902 | (05) | TX |
H27770 | (02) |