Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 18252 | TX |
N | 1223P0700X | Prosthodontist | 4443 | LA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 18252 | TX |
NPI | 1407941065 |
---|---|
Provider Name | Mark A Pigno |
First Address | Orange, TX 77632 |
Second Address | Beaumont, TX 77701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 13/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130543507 | (05) | TX |
1892955 | (05) | LA |
U57959 | (02) |