Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | K1229 | TX |
NPI | 1013939487 |
---|---|
Provider Name | Sumant G Krishnan |
First Address | Dallas, TX 75231-0806 |
Second Address | Dallas, TX 75231-0806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0193579 | LABOR DEPT WASHINGTON STA (01) | TX |
81702N | BLUE CROSS BLUE SHIELD (01) | TX |
H25097 | (02) | TX |