Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | L3736 | TX |
NPI | 1003851510 |
---|---|
Provider Name | James Edward Lusby |
First Address | Dallas, TX 75284-0020 |
Second Address | Amarillo, TX 79106-1729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 07/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
182517602 | (05) | TX |
348083ZGE1 | (02) | TX |