Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | H1883 | TX |
NPI | 1063472470 |
---|---|
Provider Name | John G Giannakis |
First Address | Shenandoah, TX 77384-3001 |
Second Address | Shenandoah, TX 77384-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 07/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140070724 | (05) | TX |
B22960 | (02) | TX |