Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 41485 | TX |
NPI | 1164434957 |
---|---|
Provider Name | Bryan Thomas Joseph Hennessy |
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 | 12/08/2006 |
Last Update Date | 17/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
182794101 | (05) | TX |
P00385878 | RAILROAD MEDICARE PART B, GROUP CS9277 (01) | TX |