Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | PA01820 | TX |
NPI | 1811005317 |
---|---|
Provider Name | Mr. Ward M Prentice |
First Address | Dickinson, TX 77539 |
Second Address | Dickinson, TX 77539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q15817 | (02) |