Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | T3362 | TX |
NPI | 1013448752 |
---|---|
Provider Name | Jonathan Edmond Pepper |
First Address | Austin, TX 78730-1167 |
Second Address | Austin, TX 78730-1167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2017 |
Last Update Date | 07/02/2022 |