Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 125-052980 | IL |
N | 208600000X | Surgeon | 125-052980 | IL |
Y | 208200000X | Surgeon | P3310 | TX |
Y | 208600000X | Surgeon | P3310 | TX |
NPI | 1003015421 |
---|---|
Provider Name | Vijian Dhevan |
First Address | Harlingen, TX 78550-8450 |
Second Address | Harlingen, TX 78550-8450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 08/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
302849006 | (05) | TX |
H08JE00001 | BCBS (01) | TX |