Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1721 | TX |
Y | 222Z00000X | Podiatrist | 1721 | TX |
NPI | 1023043585 |
---|---|
Provider Name | Johnnie B Felkins |
First Address | Amarillo, TX 79106-2108 |
Second Address | Amarillo, TX 79106-2108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 03/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V05306 | (02) | TX |