Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | K2264 | TX |
NPI | 1003005323 |
---|---|
Provider Name | Dr. Juan F Quiroz |
First Address | Dallas, TX 75226-1034 |
Second Address | Dallas, TX 75226-1034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 21/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042816102 | (05) | TX |