Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | R6117 | TX |
N | 207XS0106X | Orthopaedic Hand Surgeon | R6117 | TX |
NPI | 1114347408 |
---|---|
Provider Name | Paul Tavakolian |
First Address | Bedford, TX 76021-5011 |
Second Address | Bedford, TX 76021-5011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 30/07/2020 |