Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD423056 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | K7258 | TX |
NPI | 1063597144 |
---|---|
Provider Name | Dr. Jared P. Caruso |
First Address | Houston, TX 77030 |
Second Address | Sugarl Land, TX 77479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 29/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0022560 | (05) | NJ |
100846982 | (05) | PA |
4040384 | (05) | MD |
HO1661 | (02) |