Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | H0262 | TX |
NPI | 1497841084 |
---|---|
Provider Name | Patrick K Connolly |
First Address | Austin, TX 78705-1019 |
Second Address | Austin, TX 78705-1019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 21/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134909401 | (05) | TX |
804491 | BCBS (01) | TX |