Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | J6946 | TX |
NPI | 1679533368 |
---|---|
Provider Name | Dr. Jaime Fergie |
First Address | Corpus Christi, TX 78411-1721 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104439802 | (05) | TX |
F86309 | (02) | TX |