Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 4301062322 | MI |
Y | 207RI0200X | Infectious Disease | P2264 | TX |
NPI | 1013907831 |
---|---|
Provider Name | Duane Russell Hospenthal |
First Address | San Antonio, TX 78229-3863 |
Second Address | San Antonio, TX 78217-5407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 19/11/2020 |