Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | M4419 | TX |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M4419 | TX |
NPI | 1215016837 |
---|---|
Provider Name | Vinod Kumar Panchbhavi |
First Address | Galveston, TX 77555-1022 |
Second Address | Galveston, TX 77555-1022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 30/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162893501 | (05) | TX |
H98171 | (02) |