Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D8142 | TX |
NPI | 1073555736 |
---|---|
Provider Name | Philip C Bechtel |
First Address | Fort Worth, TX 76104-4014 |
Second Address | Fort Worth, TX 76104-4014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 21/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110110704 | (05) | TX |
8H9670 | BLUE CROSS BLUE SHIELD (01) | TX |
B21155 | (02) | TX |