Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | H1939 | TX |
NPI | 1023150083 |
---|---|
Provider Name | Dr. James Neumann Childs |
First Address | College Station, TX 77845 |
Second Address | College Station, TX 77845-8358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83X580 | BLUE CROSS BLUE SHIELD TX (01) | TX |
F26635 | (02) | TX |