Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 6005 | TX |
NPI | 1710181409 |
---|---|
Provider Name | Dr. Heith Root |
First Address | San Antonio, TX 78230-2424 |
Second Address | San Antonio, TX 78230-2424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 08/07/2007 |