Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC2949 | TX |
NPI | 1285850040 |
---|---|
Provider Name | Dr. James Gilbert Wellington |
First Address | Kingwood, TX 77339-1726 |
Second Address | Houston, TX 77015-4365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
603961 | BCBS ID NUMBER (01) | TX |