Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1665 | TX |
Y | 222Z00000X | Podiatrist | 1665 | TX |
NPI | 1003853011 |
---|---|
Provider Name | Beil Cory Brown |
First Address | Abilene, TX 79608-5409 |
Second Address | Abilene, TX 79606-5223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 01/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U96516 | (02) | TX |