Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | P1515 | TX |
Y | 207QA0401X | Family Doctor - Addiction Medicine | P1515 | TX |
NPI | 1235363862 |
---|---|
Provider Name | Dr. Bo J Allaire |
First Address | Bellaire, TX 77401-3500 |
Second Address | Bellaire, TX 77401-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2009 |
Last Update Date | 03/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
347801801 | (05) | TX |