Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 403 | TX |
N | 222Z00000X | Podiatrist | 403 | TX |
Y | 224P00000X | Prosthetist | 403 | TX |
NPI | 1053679050 |
---|---|
Provider Name | Michael Amos |
First Address | Beaumont, TX 77707-2555 |
Second Address | Beaumont, TX 77707-2555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2012 |
Last Update Date | 26/04/2012 |