Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 6689 | TX |
NPI | 1225062540 |
---|---|
Provider Name | Dr. Peter David Jaillet |
First Address | Carrollton, TX 75007-3143 |
Second Address | Carrollton, TX 75007-3143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |