Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 57.012772 | OH |
N | 111NI0900X | Internist | 57.012772 | OH |
N | 207SG0201X | Clinical Genetics (M.D.) | 57.012772 | OH |
Y | 207SG0201X | Clinical Genetics (M.D.) | 74420 | GA |
N | 207SG0201X | Clinical Genetics (M.D.) | E-7386 | AR |
NPI | 1376723619 |
---|---|
Provider Name | Jaime Enrique Vengoechea Barrios |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322-5307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2007 |
Last Update Date | 02/02/2021 |