Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | E1471 | TX |
NPI | 1003893728 |
---|---|
Provider Name | Jerome G Naifeh |
First Address | Plano, TX 75093-8134 |
Second Address | Plano, TX 75093-8134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A36668 | (02) | TX |