Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | L9216 | TX |
NPI | 1083652317 |
---|---|
Provider Name | Morris Gottlieb |
First Address | Dallas, TX 75243-1912 |
Second Address | Richardson, TX 75082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 15/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
167887201 | (05) | TX |
8P2510 | BCBS (01) | TX |
H79873 | (02) | TX |