Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | J6587 | TX |
NPI | 1043216534 |
---|---|
Provider Name | Dr. Brent Randall Mcqueen |
First Address | Kingwood, TX 77339-6005 |
Second Address | Kingwood, TX 77339-6005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100731203 | (05) | TX |
100731204 | (05) | TX |
100731205 | (05) | TX |
G67365 | (02) |