Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | H6748 | TX |
NPI | 1023077567 |
---|---|
Provider Name | Henry G. Raroque JR. |
First Address | Irving, TX 75063 |
Second Address | Irving, TX 75063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 15/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F28756 | (02) | TX |