Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | M2435 | TX |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | M2435 | TX |
NPI | 1053599563 |
---|---|
Provider Name | Luis Pacheco |
First Address | Galveston, TX 77555-1022 |
Second Address | Galveston, TX 77555-1022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2008 |
Last Update Date | 26/11/2012 |