Doctor Name: | DR. ANICETO DE LA PUERTA DOMINGUEZ |
NPI Number: | 1053561910 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | E3898 |
Business Practice Address: | 200 Spur 113 Teague, TX - 758605174 |
Business Phone Number: | 2547395555 |
Business Fax Number: | 2547395319 |
Mailing Address: | 200 Spur 113, TEAGUE |
State: | TX |
Postal Code: | 758609802 |
Phone Number: | 2547395555 |
Fax Number: | 2547395319 |
NPI Enumeration Date: | 09/26/2008 |
NPI Last Update Date: | 09/26/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | E3898 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |