Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | N6414 | TX |
NPI | 1164683249 |
---|---|
Provider Name | Dr. Eric Kavosh |
First Address | Plano, TX 75093-5910 |
Second Address | Plano, TX 75093-5910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 15/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8CT448 | BCBS (01) | TX |