Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 1750 | TX |
NPI | 1003899972 |
---|---|
Provider Name | Jonathan Gordon Wash |
First Address | Waco, TX 76710-6922 |
Second Address | Waco, TX 76710-6922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 26/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
178106401 | (05) | TX |
U84638 | (02) |