Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | F4722 | TX |
NPI | 1003856451 |
---|---|
Provider Name | Irvin E. Zeitler JR. |
First Address | San Angelo, TX 76902-7200 |
Second Address | San Angelo, TX 76903-5919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 22/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140043402 | (05) | TX |
A67841 | (02) | TX |