Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | TX1150 | TX |
NPI | 1306955471 |
---|---|
Provider Name | Thomas Shields |
First Address | Houston, TX 77002-9000 |
Second Address | Houston, TX 77002-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U17164 | (02) | TX |