Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | D7140 | TX |
NPI | 1114984259 |
---|---|
Provider Name | Bobby Quentin Lanier |
First Address | Benbrook, TX 76109-3998 |
Second Address | Benbrook, TX 76109-3998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 25/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00L511 | BC/BS PROVIDER # (01) | TX |
1058861004 | CIGNA PROVIDER # (01) | TX |
4341067 | AETNA PROVIDER # (01) | TX |
D66778 | (02) | TX |