Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | J2861 | TX |
NPI | 1962519033 |
---|---|
Provider Name | Mazen Arar |
First Address | San Antonio, TX 78229 |
Second Address | San Antonio, TX 78207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 22/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129493604 | CIDC (01) | |
129493605 | (05) | TX |