Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | C6091 | TX |
N | 208D00000X | General Practice Physician | C6091 | TX |
NPI | 1033170287 |
---|---|
Provider Name | Phillip P Saperstein |
First Address | Fort Worth, TX 76199-0335 |
Second Address | Fort Worth, TX 76115-2945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 25/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010056973 | RAILROAD MEDICARE PIN (01) | TX |
122291102 | (05) | TX |
87521G | BCBS (01) | TX |
D79648 | (02) | TX |
P01262425 | MEDICARE RAILROAD (01) | TX |