Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 10778 | TX |
NPI | 1356510911 |
---|---|
Provider Name | Dr. Joe Anthony Duarte |
First Address | San Antonio, TX 78209-4554 |
Second Address | San Antonio, TX 78209-4554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2008 |
Last Update Date | 22/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10778 | STATE LICENSE (01) | TX |