Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | BP30023497 | TX |
Y | 208600000X | Surgeon | BP30023497 | TX |
NPI | 1013111236 |
---|---|
Provider Name | John Joseph Bawduniak |
First Address | Gatesville, TX 76528-1024 |
Second Address | Gatesville, TX 76528-1024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013111236 | (02) | TX |