Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1728 | TX |
Y | 222Z00000X | Podiatrist | 1728 | TX |
NPI | 1053339713 |
---|---|
Provider Name | Milo Anderson |
First Address | San Angelo, TX 76904-7610 |
Second Address | San Angelo, TX 76904-6884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 09/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
181295002 | (05) | TX |
V09676 | (02) | TX |