Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | M9622 | TX |
N | 207YP0228X | Pediatric Otolaryngology | ME71715 | FL |
NPI | 1649295494 |
---|---|
Provider Name | Soham Roy |
First Address | Houston, TX 77216-1088 |
Second Address | Houston, TX 77030-1521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 16/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201709701 | (05) | TX |
2637677-00 | (05) | FL |
8BD694 | BCBS (01) | TX |
H67833 | (02) | FL |