Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1688 | TX |
N | 222Z00000X | Podiatrist | 1688 | TX |
Y | 224P00000X | Prosthetist | 1688 | TX |
NPI | 1063953131 |
---|---|
Provider Name | Brian James |
First Address | Carrollton, TX 75007-3428 |
Second Address | Dallas, TX 75248-3551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2017 |
Last Update Date | 09/03/2017 |