Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | L4144 | TX |
N | 207KA0200X | Allergist | L4144 | TX |
NPI | 1245285022 |
---|---|
Provider Name | Dr. Ephraim Isaac Thaller |
First Address | Waco, TX 76712-7900 |
Second Address | Waco, TX 76712-7900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 27/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00712N | MEDICARE GROUP PTAN (01) | TX |
151825100 | FIRST CARE (01) | |
180355301 | (05) | TX |
8V9670 | BCBS (01) | |
P00428353 | RAILROAD MEDICARE (01) |