Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | E1091 | TX |
NPI | 1083656094 |
---|---|
Provider Name | Dr. John Laurence Earl Nugent |
First Address | Dallas, TX 75391-1230 |
Second Address | Fort Worth, TX 76104-3926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 11/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124554001 | (05) | TX |
124554002 | (05) | TX |
124554003 | (05) | TX |
124554005 | (05) | TX |
124554006 | (05) | TX |
124554008 | (05) | TX |
8R1516 | BLUECROSS OF TEXAS (01) | TX |
B25202 | (02) | TX |