Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 916 | TX |
NPI | 1295767788 |
---|---|
Provider Name | Gerald Brian Mccool |
First Address | El Paso, TX 79912-4442 |
Second Address | El Paso, TX 79912-4442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 11/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G460 | BXBS OF TX (01) | TX |
0927899-02 | (05) | TX |
T14696 | (02) | TX |