Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | H4321 | TX |
NPI | 1114039138 |
---|---|
Provider Name | George S Fidone |
First Address | Lufkin, TX 75904 |
Second Address | Lufkin, TX 75904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |