Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | M0169 | TX |
NPI | 1659335818 |
---|---|
Provider Name | Thomas Wayne Mcgill |
First Address | Lubbock, TX 79408-5865 |
Second Address | Lubbock, TX 79430-8312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
172075701 | (05) | TX |
172075705 | (05) | TX |
F32388 | (02) |