Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | H0598 | TX |
NPI | 1003874371 |
---|---|
Provider Name | Earl Lewis Mangin JR. |
First Address | Houston, TX 77030-1521 |
Second Address | Sugar Land, TX 77479-3482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045641007 | (05) | TX |
045641009 | (05) | TX |
F26648 | (02) | TX |