Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 24263 | TX |
N | 103T00000X | Psychologist | 24263 | TX |
Y | 103TF0000X | Family Psychologist | 24263 | TX |
NPI | 1013949197 |
---|---|
Provider Name | David Egerton |
First Address | Amarillo, TX 79106-1708 |
Second Address | Amarillo, TX 79106-1786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 24/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038409102 | (05) | TX |
038409104 | (05) | TX |
100841260 A | (05) | OK |
19708017 | (05) | NM |
R69741 | (02) |