Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | G3613 | TX |
NPI | 1235219643 |
---|---|
Provider Name | Paul Minifee |
First Address | Houston, TX 77046-0297 |
Second Address | Houston, TX 77030-2316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 30/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136248502 | (05) | TX |
136248503 | (05) | TX |
136248510 | (05) | TX |
136248511 | CSHCN (01) | TX |
F57889 | (02) |