Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | L0371 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | L0371 | TX |
NPI | 1124153390 |
---|---|
Provider Name | Dr. Chau Minh Le |
First Address | Odessa, TX 79763-4206 |
Second Address | Odessa, TX 79763-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8674K2 | BCBS (01) | TX |
H21341 | (02) | TX |