Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | F2818 | TX |
Y | 207VG0400X | Gynecologist | F2818 | TX |
NPI | 1043298094 |
---|---|
Provider Name | Dr. Brent Boye Nall |
First Address | Lubbock, TX 79407-2520 |
Second Address | Lubbock, TX 79407-2520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100215106 | FIRST CARE (01) | TX |
100215106 | TEAM CHOICE CORE (01) | TX |
116082206 | (05) | TX |
4363146 | AETNA (01) | TX |
8V8690 | BCBS (01) | TX |
B25082 | (02) | TX |
P00395667 | MEDICARE RAILROAD (01) | TX |