Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | K4288 | TX |
NPI | 1194757765 |
---|---|
Provider Name | Mr. William Vota |
First Address | College Station, TX 77843-1264 |
Second Address | College Station, TX 77843-1264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 11/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030102004 | (05) | TX |
G56829 | (02) | TX |