Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | E7370 | TX |
NPI | 1124071154 |
---|---|
Provider Name | Dr. Anil Tukarampant Bangale |
First Address | River Oaks, TX 76114-2923 |
Second Address | River Oaks, TX 76114-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 06/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111743401 | (05) | TX |
B21084 | (02) | TX |