Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | E0601 | TX |
NPI | 1003836933 |
---|---|
Provider Name | Timothy J Rutz |
First Address | San Antonio, TX 78265-4717 |
Second Address | San Antonio, TX 78229-5642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D67704 | (02) |