Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 255 | TX |
Y | 222Z00000X | Podiatrist | 255 | TX |
N | 224P00000X | Prosthetist | 255 | TX |
NPI | 1164645156 |
---|---|
Provider Name | Douglas Lee Diesel |
First Address | Sherman, TX 75092-7409 |
Second Address | Sherman, TX 75092-7409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 25/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
531778 | BCBS (01) | TX |