Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | TXBL2860 | TX |
N | 207Q00000X | Family Doctor | L2860 | TX |
NPI | 1003928060 |
---|---|
Provider Name | Dr. Foy Edward Dark III |
First Address | Waco, TX 76712-8833 |
Second Address | Waco, TX 76712-8833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 03/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
147338106 | (05) | TX |
8G2620 | BC BS OF TX (01) | TX |
920116707 | RR MCR TX (01) | TX |
H48611 | (02) |