Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | J9828 | TX |
NPI | 1427048586 |
---|---|
Provider Name | Benjamin Borja Tiongson |
First Address | Bellaire, TX 77401 |
Second Address | Bellaire, TX 77401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G21175 | (02) |