Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | L6573 | TX |
NPI | 1124128749 |
---|---|
Provider Name | Demetrios Petropoulos |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
155063802 | (05) | TX |
155068303 | (05) | TX |
155068304 | CSHCN (01) | TX |
H74059 | (02) |