Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | LPO 34 | TX |
N | 222Z00000X | Podiatrist | LPO 34 | TX |
Y | 224P00000X | Prosthetist | LPO 34 | TX |
NPI | 1013142199 |
---|---|
Provider Name | Steve D Prock |
First Address | Plano, TX 75075-7752 |
Second Address | Plano, TX 75075-7752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 19/05/2009 |