Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MDF4995 | TX |
NPI | 1235155813 |
---|---|
Provider Name | Norbert Poquiz |
First Address | Fort Worth, TX 76179-2817 |
Second Address | Irving, TX 75062-6317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B25596 | (02) | TX |