Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | K0420 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | K0420 | TX |
NPI | 1336237841 |
---|---|
Provider Name | Dr. Raymond Richard Bixby |
First Address | Dallas, TX 75218-3426 |
Second Address | Dallas, TX 75218-3426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G76764 | (02) | TX |