Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | E5958 | TX |
NPI | 1053646711 |
---|---|
Provider Name | Jose R Tandoc JR. |
First Address | Spring, TX 77379-6646 |
Second Address | Spring, TX 77379-6646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2009 |
Last Update Date | 13/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C22472 | (02) | TX |