Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | H3501 | TX |
NPI | 1295718716 |
---|---|
Provider Name | Bradford Stewart Patt |
First Address | Sugar Land, TX 77478-3842 |
Second Address | Houston, TX 77024-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 21/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122688802 | (05) | TX |
D97617 | (02) | TX |