Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | M7731 | TX |
NPI | 1013139286 |
---|---|
Provider Name | Dr. John W Wages |
First Address | Dallas, TX 75373-3946 |
Second Address | Austin, TX 78759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 24/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
192377302 | (05) | TX |
8G7826 | BCBS ID (01) | TX |