Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT6556 | TX |
Y | 213ES0000X | Sports Medicine | AT6556 | TX |
NPI | 1003496811 |
---|---|
Provider Name | Taylor James Overton |
First Address | Lubbock, TX 79424-2102 |
Second Address | Lubbock, TX 79414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 14/04/2021 |