Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | J0473 | TX |
NPI | 1003888561 |
---|---|
Provider Name | Dr. Britton Michael Devillier |
First Address | Fort Worth, TX 76199-0371 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 11/04/2013 |