Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | E0560 | TX |
NPI | 1386739811 |
---|---|
Provider Name | Prof. Joe L Moake |
First Address | Houston, TX 77030 |
Second Address | Houston, TX 77030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AM2651986 | DEA LICENSE (01) | |
B95701 | (02) | TX |
E0560 | MEDICAL LICENSE (01) | TX |
F0056163 | DPS (01) | TX |