Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | K4591 | TX |
NPI | 1073529665 |
---|---|
Provider Name | Dr. Boulos Toursarkissian |
First Address | San Antonio, TX 78291-0276 |
Second Address | San Antonio, TX 78229-3342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 27/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117146402 | CIDC (01) | TX |
117146403 | (05) | TX |
117146408 | (05) | TX |
770001947 | MEDICARE RAIL ROAD (01) | TX |
80010S | BLUE CROSS BLUE SHIELD (01) | TX |
81549J | MEDICARE PIN FOR GROUP 00T148 (01) | TX |
8FA758 | BCBSTX - PVA (01) | TX |
P01465883 | MEDICARE RR - PVA (01) | TX |