Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | G3361 | TX |
NPI | 1275563785 |
---|---|
Provider Name | Michael L Foreman |
First Address | Dallas, TX 75246-2026 |
Second Address | Dallas, TX 75204-5900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 28/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114453701 | (05) | TX |
C15660 | (02) | TX |