Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | T0762 | TX |
NPI | 1326434770 |
---|---|
Provider Name | Iyooh Uchechuwu Davidson |
First Address | Plano, TX 75093-8172 |
Second Address | Ft Worth, TX 76104-7400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2015 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T0762 | TMB (01) | TX |