Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | H7135 | TX |
NPI | 1023123478 |
---|---|
Provider Name | John S Dallas |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E20062 | (02) |