Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 510 | TX |
N | 225000000X | Orthotic Fitter | 1144 | TX |
NPI | 1770716375 |
---|---|
Provider Name | Gordon E North |
First Address | Fort Worth, TX 76104-4250 |
Second Address | Fort Worth, TX 76104-4250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2009 |
Last Update Date | 28/08/2009 |