Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | S0879 | TX |
NPI | 1003347972 |
---|---|
Provider Name | Zachary Foughty |
First Address | Houston, TX 77030-2358 |
Second Address | Houston, TX 77030-2358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 12/01/2022 |