Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | E7794 | TX |
NPI | 1861452203 |
---|---|
Provider Name | Dr. William Allen |
First Address | Corpus Christi, TX 78466-6696 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C12718 | (02) | TX |