Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | F7154 | TX |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | F7154 | TX |
NPI | 1700871498 |
---|---|
Provider Name | Richard R Selvaggi |
First Address | Commerce, TX 75428-2551 |
Second Address | Commerce, TX 75428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 18/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111557801 | (05) | TX |
111557802 | (05) | TX |
114613601 | (05) | TX |
B26341 | (02) | TX |