Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD042341 | DC |
Y | 2080P0208X | Pediatric Infectious Diseases | R3069 | TX |
NPI | 1346526324 |
---|---|
Provider Name | Gueorgui Dubrocq |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76502-1814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2011 |
Last Update Date | 07/01/2021 |