Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | TX 1295 | TX |
Y | 222Z00000X | Podiatrist | TX 1295 | TX |
NPI | 1003808064 |
---|---|
Provider Name | Dr. Brian Erwin Sicher |
First Address | Amarillo, TX 79124-2105 |
Second Address | Amarillo, TX 79124-2105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 02/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00R52M | BLUE CROSS BLUE SHIELD (01) | TX |
130987406 | (05) | TX |
480029628 | RAILROAD MEDICARE (01) | TX |
U55375 | (02) |