Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | L6147 | TX |
NPI | 1891783122 |
---|---|
Provider Name | Mr. John Franklin Priddy |
First Address | Tyler, TX 75713-0189 |
Second Address | Tyler, TX 75701-8336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 21/01/2015 |