Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | S0278 | TX |
NPI | 1528333770 |
---|---|
Provider Name | David Booty Doherty JR. |
First Address | Houston, TX 77030-1526 |
Second Address | Bellaire, TX 77401-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 15/10/2019 |