Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 1670 | PA |
Y | 208600000X | Surgeon | 1670 | PA |
N | 2082S0105X | Plastic Hand Surgeon | 1670 | PA |
N | 208D00000X | General Practice Physician | 1670 | PA |
NPI | 1457379182 |
---|---|
Provider Name | Paul E Mondolfi |
First Address | Victoria, TX 77901 |
Second Address | Victoria, TX 77901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 07/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035997801 | (05) | TX |
089873601 | (05) | TX |
240005657 | TRAVELERS MEDICARE # (01) | TX |
837417 | BC/BS# (01) | TX |
8DF122 | BC/BS # (01) | TX |
G18184 | (02) | |
MDJ9761TX | WORKERS COMP # (01) | TX |