Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | R1109 | TX |
NPI | 1003060211 |
---|---|
Provider Name | Vichin Puri |
First Address | Dallas, TX 75237 |
Second Address | Dallas, TX 75203-7520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2008 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03977069 | (05) | MS |
201068001 | (05) | AR |
6002233 | BCBS (01) | TN |
P01473968 | RAILROAD MEDICARE (01) | TN |
Q002437 | (05) | TN |