Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | M8617 | TX |
Y | 2080P0214X | Pediatric Pulmonologist | M8617 | TX |
NPI | 1013235233 |
---|---|
Provider Name | Dr. Shailendra Das |
First Address | Fort Worth, TX 76199-0371 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2010 |
Last Update Date | 05/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
282070602 | (05) | TX |
282070604 | (05) | TX |