Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 1.056429 | CT |
Y | 207W00000X | Ophthalmologist | S0733 | TX |
NPI | 1023454386 |
---|---|
Provider Name | Fuad Makkouk |
First Address | Austin, TX 78750-0017 |
Second Address | Austin, TX 78750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 27/05/2020 |