Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | H0410 | TX |
NPI | 1023066552 |
---|---|
Provider Name | Michael Edward Guerra |
First Address | Kerrville, TX 78028-5809 |
Second Address | Kerrville, TX 78028-5809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
089638301 | (05) | TX |
E04404 | (02) | TX |