Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | K1922 | TX |
NPI | 1023099082 |
---|---|
Provider Name | Gregg M Santilli |
First Address | Dallas, TX 75231-3833 |
Second Address | Plano, TX 75093-8157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 04/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1206104 | (05) | TX |
F75545 | (02) | TX |