Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | G0421 | TX |
NPI | 1013130640 |
---|---|
Provider Name | Dr. Roger Guthrie |
First Address | Colleyville, TX 76034-7211 |
Second Address | Colleyville, TX 76034-7211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 12/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D97362 | (02) | TX |