Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | H6243 | TX |
NPI | 1144278326 |
---|---|
Provider Name | Marcus Gitterle |
First Address | Lubbock, TX 79424-2525 |
Second Address | New Braunfels, TX 78130-4179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 25/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140039227 | (05) | TX |
E12496 | (02) | TX |