Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G3614 | TX |
NPI | 1114925229 |
---|---|
Provider Name | Mr. Gregory Robert Misenhimer |
First Address | El Paso, TX 79902-2921 |
Second Address | El Paso, TX 79902-2921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 07/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120130301 | (05) | TX |
B24932 | (02) | TX |