Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1022 | TX |
Y | 222Z00000X | Podiatrist | 1022 | TX |
NPI | 1053426601 |
---|---|
Provider Name | Kenneth Lynn James |
First Address | Fort Worth, TX 76104 |
Second Address | Fort Worth, TX 76104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 19/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T14031 | (02) |