Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G3301 | TX |
NPI | 1023036084 |
---|---|
Provider Name | Harry Anderson Dollahite |
First Address | Fort Worth, TX 76161-1205 |
Second Address | Fort Worth, TX 76104-4111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 18/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173988001 | (05) | TX |
P00247392 | RAILROAD MEDICARE (01) |