Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | H8212 | TX |
NPI | 1407963796 |
---|---|
Provider Name | Byron Lee Limmer |
First Address | San Antonio, TX 78249-1373 |
Second Address | San Antonio, TX 78232-4374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 18/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F28753 | (02) | TX |