Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | L3714 | TX |
NPI | 1003873944 |
---|---|
Provider Name | Dr. David Kerek |
First Address | Corpus Christi, TX 78466-6696 |
Second Address | Corpus Christi, TX 78405-1818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E57647 | (02) | TX |