Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 2186 | TX |
Y | 222Z00000X | Podiatrist | 2186 | TX |
N | 224P00000X | Prosthetist | 2186 | TX |
NPI | 1396413977 |
---|---|
Provider Name | Samuel Paul Devereux |
First Address | Dallas, TX 75235-1838 |
Second Address | Dallas, TX 75235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2021 |
Last Update Date | 16/09/2021 |