Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 7991 | TX |
NPI | 1356346613 |
---|---|
Provider Name | Thomas Maurice Weil |
First Address | Houston, TX 77056-2410 |
Second Address | Houston, TX 77063-2320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 24/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T16532 | (02) |