Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | J0491 | TX |
NPI | 1235246224 |
---|---|
Provider Name | Peter T Fox |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 10/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
219529901 | (05) | TX |