Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 9945 | TX |
NPI | 1558545228 |
---|---|
Provider Name | Dr. Roger Borbon |
First Address | West Lake Hills, TX 78746-5280 |
Second Address | West Lake Hills, TX 78746-5280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2007 |
Last Update Date | 18/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V04296 | (02) | TX |