Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP142811 | TX |
NPI | 1265089692 |
---|---|
Provider Name | Brandon Allen Gauthier |
First Address | San Antonio, TX 78253-4765 |
Second Address | San Antonio, TX 78229-3902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2019 |
Last Update Date | 21/08/2019 |