Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | M2275 | TX |
NPI | 1982620415 |
---|---|
Provider Name | Dr. Roderick Marcus Capelo |
First Address | Grapevine, TX 76051-8649 |
Second Address | Grapevine, TX 76051-8649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 14/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176721204 | (05) | TX |
176721206 | (05) | TX |
I43503 | (02) | TX |