Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1241 | TX |
Y | 222Z00000X | Podiatrist | 1241 | TX |
NPI | 1033199963 |
---|---|
Provider Name | Samuel Nava JR. |
First Address | Carrollton, TX 75010-4629 |
Second Address | Carrollton, TX 75010-4629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 14/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000880211 | DPS (01) | TX |
121580801 | (05) | TX |
BN4591182 | DEA (01) | TX |
U47826 | (02) | TX |