Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 16833 | TX |
NPI | 1003992314 |
---|---|
Provider Name | Bruce William Gopin |
First Address | El Paso, TX 79925-8056 |
Second Address | El Paso, TX 79925-8056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2006 |
Last Update Date | 26/01/2010 |