Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | G7835 | TX |
NPI | 1245260280 |
---|---|
Provider Name | Dr. Goran B. G. Klintmalm |
First Address | Dallas, TX 75246-2003 |
Second Address | Dallas, TX 75246-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 20/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041146403 | (05) | TX |
041146404 | (05) | TX |
8H3710 | BCBS (01) | TX |
B24016 | (02) | TX |