Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 10347 | SC |
NPI | 1164470159 |
---|---|
Provider Name | Robert Eric Houston |
First Address | Atlanta, GA 30374-3070 |
Second Address | Spartanburg, SC 29303-3040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103471 | (05) | SC |
AA48855019 | MEDICARE PIN (01) | SC |
B678963365 | MEDICARE PIN (01) | SC |
P01221628 | RAILROAD MEDICARE (01) | SC |