Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 219 | NM |
N | 213ES0103X | Foot & Ankle Surgery | 219 | NM |
NPI | 1417993445 |
---|---|
Provider Name | Theodore Lawrence Varoz |
First Address | Albuquerque, NM 87107-2766 |
Second Address | Albuquerque, NM 87107-2766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
53363 | (05) | NM |
BV2179857 | FEDERAL DEA (01) | |
CS00010705 | CONTROLLED SUBSTANCE REGI (01) | NM |
T41104 | (02) |