Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | C7410 | TX |
NPI | 1063562635 |
---|---|
Provider Name | Dr. Nick J Patzakis |
First Address | Houston, TX 77016-4403 |
Second Address | Houston, TX 77016-4403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 19/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009496 | (02) | |
121543603 | (05) | TX |
A67483 | (02) | TX |