Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | D7693 | TX |
N | 207U00000X | Nuclear Medicine Specialist | D7693 | TX |
NPI | 1740283043 |
---|---|
Provider Name | Wilbur J Strader |
First Address | El Paso, TX 79995-9520 |
Second Address | El Paso, TX 79902-4660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C22334 | (02) | TX |
Z00BA817 | (05) | TX |