Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | Q5404 | TX |
NPI | 1275890634 |
---|---|
Provider Name | Dr. Thomas Patrick Fogarty III |
First Address | Houston, TX 77030-3411 |
Second Address | Houston, TX 77030-3411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 23/04/2018 |