Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | P8578 | TX |
NPI | 1760476337 |
---|---|
Provider Name | Mr. Paul Anthony Bednarz |
First Address | Waco, TX 76710-6922 |
Second Address | Waco, TX 76710-6922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8913078 | (05) | NC |
H00934 | (02) | NC |