Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 39071 | CO |
NPI | 1043296478 |
---|---|
Provider Name | John Badalamenti |
First Address | Galveston, TX 77555-0562 |
Second Address | Galveston, TX 77555-0562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2005 |
Last Update Date | 13/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06024742 | (05) | CO |
E070160 | (02) |