Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | E2078 | AR |
Y | 208800000X | Urologist | J4621 | TX |
NPI | 1003816901 |
---|---|
Provider Name | Joseph Sean Womack |
First Address | Texarkana, TX 75503-9766 |
Second Address | Texarkana, TX 75503-9766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F75012 | (02) |