Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | AP108274 | TX |
NPI | 1003567447 |
---|---|
Provider Name | Mr. Paul Joseph Fanucchi |
First Address | San Antonio, TX 78228-4821 |
Second Address | San Antonio, TX 78228-4821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2022 |
Last Update Date | 18/01/2022 |