Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036-115001 | IL |
Y | 207V00000X | Obstetrician & Gynecologist | N4270 | TX |
N | 207VG0400X | Gynecologist | 036-115001 | IL |
N | 207VG0400X | Gynecologist | N4270 | TX |
N | 207VX0000X | Obstetrician | 036-115001 | IL |
N | 207VX0000X | Obstetrician | N4270 | TX |
NPI | 1295948594 |
---|---|
Provider Name | George Todorov Backardjiev |
First Address | Port Neches, TX 77651-5421 |
Second Address | Port Neches, TX 77651-5421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 03/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194047084 | (05) | TX |
1295948594 | (05) | TX |