Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 99078520A | IN |
Y | 208D00000X | General Practice Physician | MD459732 | PA |
NPI | 1023350147 |
---|---|
Provider Name | Christopher Loo |
First Address | Houston, TX 77054-3217 |
Second Address | Houston, TX 77054-3217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2013 |
Last Update Date | 23/03/2017 |