Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 5045 | TX |
NPI | 1346362670 |
---|---|
Provider Name | Larry David Jones |
First Address | El Paso, TX 79912-3653 |
Second Address | El Paso, TX 79912-3653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 27/11/2007 |