Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 238724 | NY |
Y | 207U00000X | Nuclear Medicine Specialist | P1213 | TX |
NPI | 1649447525 |
---|---|
Provider Name | Gregory Calderoni Ravizzini |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2008 |
Last Update Date | 27/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286780601 | (05) | TX |
8W5241 | BCBS (01) | TX |