Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | M4463 | TX |
NPI | 1144361809 |
---|---|
Provider Name | Brian L Ransdell |
First Address | Spicewood, TX 78669-2631 |
Second Address | Spicewood, TX 78669-6776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 21/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
186397901 | (05) | TX |
186397903 | (05) | TX |