Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | P8278 | TX |
Y | 207RP1001X | Pulmonary Disease | P8278 | TX |
NPI | 1003012477 |
---|---|
Provider Name | Dr. Ariel Marcelo Modrykamien |
First Address | Dallas, TX 75246-1800 |
Second Address | Dallas, TX 75246-1800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 16/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
337372201 | (05) | TX |