Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | L0234 | TX |
NPI | 1548509532 |
---|---|
Provider Name | Mr. Benjamin George |
First Address | Fort Worth, TX 76104-3033 |
Second Address | Fort Worth, TX 76104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2013 |
Last Update Date | 15/08/2019 |