Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | M2757 | TX |
NPI | 1043390461 |
---|---|
Provider Name | Jochen Profit |
First Address | Houston, TX 77030-2303 |
Second Address | Houston, TX 77030-2303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 06/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176673501 | (05) | TX |
I44668 | (02) |