Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | N2602 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | N2602 | TX |
NPI | 1093919664 |
---|---|
Provider Name | Dr. Justin John Klimisch |
First Address | Corpus Christi, TX 78411-2549 |
Second Address | Corpus Christi, TX 78411-2549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 27/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0263320 | L&I (01) | WA |
313657401 | (05) | TX |