Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | S0650 | TX |
N | 207ND0101X | MOHS-Micrographic Surgeon | S0650 | TX |
NPI | 1336536143 |
---|---|
Provider Name | Daniel Condie |
First Address | Dallas, TX 75230-5826 |
Second Address | Gilbert, AZ 85297-7318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 27/07/2021 |