Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1411 | TX |
N | 222Z00000X | Podiatrist | 1411 | TX |
Y | 224P00000X | Prosthetist | 1411 | TX |
NPI | 1235497231 |
---|---|
Provider Name | Justin Pfaff |
First Address | El Paso, TX 79935-3027 |
Second Address | El Paso, TX 79935-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2012 |
Last Update Date | 26/04/2012 |