Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | L5212 | TX |
NPI | 1023098357 |
---|---|
Provider Name | Hunter M Addis |
First Address | San Antonio, TX 78229-3824 |
Second Address | San Antonio, TX 78229-3824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 02/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F92632 | (02) | TX |
L5212 | TEXAS MEDICAL LICENSE # (01) | TX |