Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | D8175 | TX |
NPI | 1023029675 |
---|---|
Provider Name | M Bruce Christopherson |
First Address | Houston, TX 77024-2515 |
Second Address | Houston, TX 77024-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 12/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D98081 | (02) | TX |