Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 27885 | TX |
Y | 213EG0000X | General Practice | 27885 | TX |
NPI | 1003104977 |
---|---|
Provider Name | Jonathan Charles Ames |
First Address | Round Rock, TX 78681-4943 |
Second Address | Round Rock, TX 78681-4943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 27/06/2012 |