Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | E0062 | TX |
NPI | 1013941665 |
---|---|
Provider Name | David G Jansma |
First Address | Greenville, TX 75403 |
Second Address | Waco, TX 76708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133852705 | (05) | TX |
133852708 | (05) | TX |
C17413 | (02) |