Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 00988161 | SD |
NPI | 1023785664 |
---|---|
Provider Name | Patrick Kasong Muyej |
First Address | Dallas, TX 75243-0542 |
Second Address | Dallas, TX 75243-0542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2021 |
Last Update Date | 23/08/2021 |