Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | M6388 | TX |
NPI | 1215148200 |
---|---|
Provider Name | Dr. Ganesh Shanmugam |
First Address | College Station, TX 77845-8306 |
Second Address | College Station, TX 77845-8306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 30/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3201428 | (05) | TX |