Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | F7663 | TX |
NPI | 1134121791 |
---|---|
Provider Name | Dr. Armand L Wiltz |
First Address | Lubbock, TX 79413-2438 |
Second Address | Seminole, TX 79360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C23657 | (02) | TX |