Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | M1495 | TX |
NPI | 1033188776 |
---|---|
Provider Name | Dr. Deno B Barroga |
First Address | Dallas, TX 75231-3831 |
Second Address | Dallas, TX 75231-3831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 08/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175167901 | (05) | TX |
8S8080 | BCBS (01) | TX |
I33438 | (02) |