Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | M3528 | TX |
NPI | 1003854076 |
---|---|
Provider Name | Sunil K Dwivedi |
First Address | San Antonio, TX 78229-3327 |
Second Address | San Antonio, TX 78229-4463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
174532504 | (05) | TX |
8CJ470 | BLUE CROSS BLUE SHIELD OF TEXAS (01) | |
TXB105184 | MEDICARE (01) | TX |