Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | BP10066742 | TX |
NPI | 1063830909 |
---|---|
Provider Name | Mr. Tyler Janz |
First Address | Galveston, TX 77555-0521 |
Second Address | Galveston, TX 77555-0521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2014 |
Last Update Date | 07/05/2019 |