Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | K1080 | TX |
NPI | 1144230673 |
---|---|
Provider Name | Theodore Sugihara |
First Address | Arlington, TX 76018-1532 |
Second Address | Arlington, TX 76018-1532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007260022 | AETNA (01) | TX |
8M9080 | BLUE CROSS BLUE SHIELD (01) | TX |