Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | BP10060961 | TX |
NPI | 1063949311 |
---|---|
Provider Name | Abigail Forbes |
First Address | Galveston, TX 77555-0724 |
Second Address | Galveston, TX 77555-5302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2017 |
Last Update Date | 17/05/2017 |