Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | L7429 | TX |
Y | 208600000X | Surgeon | L7429 | TX |
NPI | 1013959584 |
---|---|
Provider Name | Dr. Matthew Theophil Janzow |
First Address | Victoria, TX 77901-6004 |
Second Address | Victoria, TX 77901-6004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8K8401 | BLUECROSS BLUESHIELD (01) | TX |
I01606 | (02) | TX |
P00094821 | RAILROAD MEDICARE (01) | TX |