Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | L2174 | TX |
NPI | 1013951110 |
---|---|
Provider Name | Jorge Casas |
First Address | Dallas, TX 75243-3720 |
Second Address | Dallas, TX 75243-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 23/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149969103 | (05) | TX |
8F4097 | (02) | |
8W5930 | BCBS (01) |