Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | P7504 | TX |
NPI | 1003157561 |
---|---|
Provider Name | Joey Mayor |
First Address | Dallas, TX 75201-5964 |
Second Address | Fort Worth, TX 76104-4110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2013 |
Last Update Date | 06/08/2013 |