Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | M2846 | TX |
NPI | 1144285966 |
---|---|
Provider Name | Uttam Tripathy |
First Address | Houston, TX 77254 |
Second Address | Sugar Land, TX 77479-3501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 01/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04865986 | ECFMG (01) | |
178464701 | (05) | TX |
8G5886 | BCBS (01) | TX |
I47018 | (02) |