Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 20680 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 20680 | TX |
NPI | 1750475224 |
---|---|
Provider Name | Dr. Nadarajah Vigneswaran |
First Address | Dallas, TX 75303-1173 |
Second Address | Houston, TX 77054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 14/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190010074 | RAILROAD MEDICARE (01) | TX |
87D869 | BLUE CROSS BLUE SHIELD (01) | TX |
U69456 | (02) | TX |