Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | Q0998 | TX |
NPI | 1457426280 |
---|---|
Provider Name | Dr. Matthew Ryan Porembka |
First Address | Dallas, TX 75390-8548 |
Second Address | Dallas, TX 75390-8548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 22/07/2014 |