Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35099973 | OH |
Y | 2080P0204X | Pediatric Emergency Doctor | 35099973 | OH |
NPI | 1205018546 |
---|---|
Provider Name | Dr. John Roy Bahling |
First Address | Austin, TX 78723 |
Second Address | Austin, TX 78723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 29/08/2016 |