Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | S9489 | TX |
NPI | 1003342833 |
---|---|
Provider Name | Dr. Andrew Decrescenzo |
First Address | Galveston, TX 77555-5302 |
Second Address | Galveston, TX 77555-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 08/07/2021 |