Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | R0524 | TX |
NPI | 1184690489 |
---|---|
Provider Name | Dr. Dane Kent Wukich |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-8883 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 10/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001239430 | (05) | TX |
E83727 | (02) | TX |