Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 13204 | ND |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | M7303 | TX |
NPI | 1033221486 |
---|---|
Provider Name | Mark Lee Jayawant |
First Address | Georgetown, TX 78626 |
Second Address | Georgetown, TX 78626-7724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 01/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H81184 | (02) | SC |