Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | L8469 | TX |
NPI | 1083686612 |
---|---|
Provider Name | Michael Vincent Passanante |
First Address | Dallas, TX 75203 |
Second Address | Dallas, TX 75203-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 28/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H63377 | (02) | TX |