Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0881 | TX |
Y | 222Z00000X | Podiatrist | 0881 | TX |
NPI | 1023014917 |
---|---|
Provider Name | Mr. Thomas E Brooks III |
First Address | Harlingen, TX 78550-8235 |
Second Address | Harlingen, TX 78550-8235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 21/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112214501 | (05) | TX |
112214502 | (05) | TX |
T12388 | (02) | TX |