Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 072668 | GA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | R1450 | TX |
NPI | 1003178146 |
---|---|
Provider Name | Dr. John David R. Seno |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003150414A | (05) | GA |
GA1680 | (05) | SC |