Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD431465 | PA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD431465 | PA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | R9478 | TX |
NPI | 1003995218 |
---|---|
Provider Name | John J. Christoforetti II |
First Address | Allen, TX 75013-5258 |
Second Address | Allen, TX 75013-5258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 27/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102003882 | (05) | PA |
I68758 | (02) |