Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | Q8371 | TX |
N | 207P00000X | Emergency Physician | TRN17251 | FL |
NPI | 1003175233 |
---|---|
Provider Name | Matthew Tice |
First Address | Dallas, TX 75251-2202 |
Second Address | Dallas, TX 75251-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2012 |
Last Update Date | 29/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014953600 | (05) | FL |