Individual
THEODORE SUGIHARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5421 MATLOCK RD, ARLINGTON, TX 76018-1532
(817) 460-7447
Mailing address
5421 MATLOCK RD, ARLINGTON, TX 76018-1532
(817) 460-7447
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
K1080
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007260022
AETNA
TX
01
—
8M9080
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/08/2006
Last updated
07/08/2007
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