Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | N1174 | TX |
Y | 207PP0204X | Pediatric Emergency Physician | N1174 | TX |
N | 208000000X | Pediatrician | BP1-0023124 | TX |
NPI | 1497950075 |
---|---|
Provider Name | Dr. Mark Dariush Tabarrok |
First Address | Austin, TX 78738-6162 |
Second Address | Austin, TX 78723-3079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3805159112 | MYUTMB 3805159112-COMMERCIAL NUMBER (01) |