Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | K3815 | TX |
NPI | 1003825266 |
---|---|
Provider Name | Rafael Ortiz-Colberg |
First Address | Webster, TX 77598 |
Second Address | Webster, TX 77598 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
145852301 | (05) | TX |
G55801 | (02) | TX |