Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | N6375 | TX |
NPI | 1003050402 |
---|---|
Provider Name | Dr. Marcos Hiroshi Ikeda |
First Address | Houston, TX 77091-4352 |
Second Address | Houston, TX 77091-4352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2009 |
Last Update Date | 16/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065075 | ECFMG (01) | FL |
FI1999828 | DEA (01) | TX |
R0172459 | DPS (01) | TX |