Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 2132 | TX |
NPI | 1467047886 |
---|---|
Provider Name | Douglas Hebert |
First Address | San Antonio, TX 78229-5641 |
Second Address | Corpus Christi, TX 78405-4200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2021 |
Last Update Date | 08/03/2021 |