Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | E5945 | TX |
NPI | 1093821191 |
---|---|
Provider Name | Kent K Sorajja |
First Address | Amarillo, TX 79106 |
Second Address | Amarillo, TX 79106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
097335601 | (05) | TX |
B26572 | (02) |