Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | F2912 | TX |
N | 2080A0000X | Adolescent Medicine | F2912 | TX |
NPI | 1104933522 |
---|---|
Provider Name | Manuel Schydlower |
First Address | El Paso, TX 79995-9520 |
Second Address | El Paso, TX 79905-9520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
838725 | BC/BS OF TEXAS (01) | TX |
F87400 | (02) | TX |