Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | K8266 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | K8266 | TX |
NPI | 1174589378 |
---|---|
Provider Name | Danny Michael Kofos |
First Address | San Antonio, TX 78229-3311 |
Second Address | San Antonio, TX 78229-3902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 20/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105043711 TRAD | (05) | TX |
105043712 CSN | (05) | TX |
8DL540 | BCBS (01) | TX |