Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | L7488 | TX |
NPI | 1053377036 |
---|---|
Provider Name | Dr. Ignacio Montemayor JR. |
First Address | Victoria, TX 77901-5754 |
Second Address | Victoria, TX 77901-5754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H95975 | (02) | TX |