Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12089 | TX |
NPI | 1881640779 |
---|---|
Provider Name | Dr. Seth L Witcher |
First Address | San Antonio, TX 78232-1321 |
Second Address | San Antonio, TX 78222-3641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T16704 | (02) | TX |