Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | F1547 | TX |
NPI | 1023064268 |
---|---|
Provider Name | Dr. James P Fogarty |
First Address | Houston, TX 77065-3840 |
Second Address | Houston, TX 77065-3840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 05/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114911404 | (05) | TX |
8F4300 | BCBS PROVIDER NUMBER (01) | TX |