Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | G5089 | TX |
NPI | 1003829920 |
---|---|
Provider Name | Dr. John Joseph Ghidoni III |
First Address | Austin, TX 78757-7568 |
Second Address | Austin, TX 78757-7568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B58938 | (02) | TX |