Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | H9304 | TX |
NPI | 1831127620 |
---|---|
Provider Name | Fred Jay Bressler |
First Address | Houston, TX 77030-2732 |
Second Address | Houston, TX 77030-2732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00K65F | BLUE CROSS/BLUE SHIELD TX (01) | TX |
099172102 | (05) | TX |
099172103 | (05) | TX |
760388511 | TAX ID (01) | |
F49687 | (02) | |
H9304 | STATE LIC (01) |