Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 8576 | TX |
NPI | 1366488819 |
---|---|
Provider Name | James R Kieser II |
First Address | Sachse, TX 75048-3773 |
Second Address | Sachse, TX 75048-3773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 22/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8A7641 | BCBS INDIVIDUAL ID# (01) | TX |
U95136 | (02) | TX |