Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | E 4132 | TX |
Y | 208200000X | Surgeon | E4132 | TX |
Y | 208600000X | Surgeon | E4132 | TX |
NPI | 1023026390 |
---|---|
Provider Name | Dr. Jaime Pankowsky |
First Address | San Antonio, TX 78240-1532 |
Second Address | San Antonio, TX 78205-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 12/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00B512 | (02) | TX |
032103601 | (05) | TX |
0321036-01 | (05) | TX |