Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | Q2754 | TX |
NPI | 1043538564 |
---|---|
Provider Name | Dr. Brandon Lee Christianson |
First Address | Fort Worth, TX 76244-8905 |
Second Address | Fort Worth, TX 76244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2010 |
Last Update Date | 20/06/2018 |