Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 31880 | TX |
NPI | 1073055653 |
---|---|
Provider Name | Dr. Caio Randi Ferraz |
First Address | Boerne, TX 78015-4883 |
Second Address | San Antonio, TX 78229-3923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2016 |
Last Update Date | 16/11/2016 |