Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 8341 | TX |
NPI | 1669450060 |
---|---|
Provider Name | Dr. Lewis Cone |
First Address | Dallas, TX 75243-6179 |
Second Address | Dallas, TX 75243-6179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 31/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
608082 | BLUE CROSS/BS ID # (01) | TX |
V03863 | (02) | TX |