Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | N2103 | TX |
NPI | 1053450304 |
---|---|
Provider Name | Nathan Wayne Hales |
First Address | San Antonio, TX 78229-3456 |
Second Address | San Antonio, TX 78229-3456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 02/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202003401 | (05) | TX |