Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | H6426 | TX |
Y | 207PE0004X | Emergency Medical Services | H6426 | TX |
NPI | 1013963123 |
---|---|
Provider Name | Rex E. Medford |
First Address | Austin, TX 78750-4024 |
Second Address | Austin, TX 78705-2703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 14/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
118421002 | (05) | TX |
118421004 | (05) | TX |
E97715 | (02) | TX |