Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 37073 | AL |
Y | 207VX0201X | Gynecologic Oncologist | T3175 | TX |
NPI | 1205256047 |
---|---|
Provider Name | Brandon Roane |
First Address | Birmingham, AL 35255-5310 |
Second Address | Dallas, TX 75208-2363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2014 |
Last Update Date | 09/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
428271702 | (05) | TX |
428271703 | (05) | TX |