Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | K5370 | TX |
Y | 207Q00000X | Family Doctor | K5370 | TX |
NPI | 1134184716 |
---|---|
Provider Name | Mr. Christopher M Opella |
First Address | Azle, TX 76020-2930 |
Second Address | Azle, TX 76020-2930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 06/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009DV | BLUE CROSS BLUE SHIELD (01) | TX |
162606101 | (05) | TX |
8DM120 | BCBS (01) | TX |
G79199 | (02) | TX |