Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | H6812 | TX |
N | 208000000X | Pediatrician | H6812 | TX |
Y | 2080P0204X | Pediatric Emergency Doctor | TMD004700 | PA |
NPI | 1194733485 |
---|---|
Provider Name | Dr. Jose L. Enriquez |
First Address | Danville, PA 17822-4903 |
Second Address | Wilkes Barre, PA 18711-0027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 11/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138234322 | (05) | TX |
138234323 | CSHCN (01) | TX |
259843YK00 | (02) | TX |
8V1710 | BCBS # (01) | TX |