Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | E7002 | TX |
NPI | 1063444222 |
---|---|
Provider Name | Boutros Boutros |
First Address | Houston, TX 77082 |
Second Address | Houston, TX 77082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 14/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B21425 | (02) | TX |
BB30 | BCBS (01) | TX |