Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | C8419 | TX |
N | 208800000X | Urologist | C8419 | TX |
NPI | 1033217542 |
---|---|
Provider Name | Dr. Bill Risk |
First Address | Hurst, TX 76054-2707 |
Second Address | Hurst, TX 76054-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 14/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B25942 | (02) |