Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 149697 | TX |
NPI | 1003007717 |
---|---|
Provider Name | Moises Farrera |
First Address | El Paso, TX 79996 |
Second Address | Cd Juarez, MX 32310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 06/10/2008 |