Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | A112187 | CA |
Y | 207PE0004X | Emergency Medical Services | N6583 | TX |
NPI | 1063693125 |
---|---|
Provider Name | Jeffery M Pinnow |
First Address | Odessa, TX 79765-8620 |
Second Address | Odessa, TX 79761-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 06/01/2012 |