Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | H1363 | TX |
NPI | 1477660462 |
---|---|
Provider Name | Terence I Doran |
First Address | San Antonio, TX 78229-3900 |
Second Address | San Antonio, TX 78207-3110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125066403 | (05) | TX |