Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D6844 | TX |
NPI | 1033274998 |
---|---|
Provider Name | Dr. Frederick Merrill Pevow |
First Address | Houston, TX 77057-1302 |
Second Address | Houston, TX 77057-1302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 08/07/2007 |