Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | G3502 | TX |
NPI | 1013020080 |
---|---|
Provider Name | Michael L Jones |
First Address | San Antonio, TX 78229-3905 |
Second Address | San Antonio, TX 78229-3905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 19/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126496203 | (05) | TX |
400000581 | MEDICARE RAILROAD (01) | TX |
E07324 | (02) |