Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 45 | TX |
N | 222Z00000X | Podiatrist | 45 | TX |
Y | 224P00000X | Prosthetist | 45 | TX |
NPI | 1194048074 |
---|---|
Provider Name | Mr. Greg Frank Cdebaca |
First Address | Baytown, TX 77521-2281 |
Second Address | Baytown, TX 77521-2281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2010 |
Last Update Date | 08/03/2010 |