Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 111 | TX |
Y | 222Z00000X | Podiatrist | 111 | TX |
N | 224P00000X | Prosthetist | 111 | TX |
NPI | 1144631045 |
---|---|
Provider Name | Mr. Donald Virostek |
First Address | Dallas, TX 75219-3924 |
Second Address | Dallas, TX 75219-3924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 10/02/2016 |