Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | M9921 | TX |
NPI | 1073770038 |
---|---|
Provider Name | Dr. Charlie Cheng |
First Address | Galveston, TX 77555-0735 |
Second Address | Galveston, TX 77555-0735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 16/02/2012 |