Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | K8186 | TX |
NPI | 1073504312 |
---|---|
Provider Name | Mr. Andamo A Guillaume |
First Address | San Antonio, TX 78258 |
Second Address | San Antonio, TX 78217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 25/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030716702 | (05) | TX |
G81945 | (02) | TX |