Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | M0068 | TX |
NPI | 1023167095 |
---|---|
Provider Name | Dr. Mingiziem Emiru |
First Address | Tyler, TX 75701-2130 |
Second Address | Tyler, TX 75701-2130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 29/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175014301 | (05) | TX |
200214920 A | (05) | OK |
I22191 | (02) | |
P00256304 | RAILROAD MEDICARE (01) |