Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | L4093 | TX |
NPI | 1053365304 |
---|---|
Provider Name | Mr. Jeffrey B Phelps |
First Address | North Richland Hills, TX 76182-8461 |
Second Address | North Richland Hills, TX 76182-8461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 10/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I34337 | (02) | TX |
L4093 | TX LICENSE NUMBER (01) | TX |