Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | R4487 | TX |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | R4487 | TX |
NPI | 1548557051 |
---|---|
Provider Name | Brittny Nicole Tillman |
First Address | Dallas, TX 75284-5317 |
Second Address | Dallas, TX 75390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 28/09/2018 |