Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC7412 | TX |
N | 111NN0400X | Neurology | DC7412 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 777944 | TX |
NPI | 1396859211 |
---|---|
Provider Name | Dr. Thimios D. Partalas |
First Address | San Antonio, TX 78215-1918 |
Second Address | San Antonio, TX 78215-1918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 05/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8B0156 | BLUE CROSS BLUE SHIELD TX (01) | TX |