Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | Q9302 | TX |
NPI | 1114289329 |
---|---|
Provider Name | Dr. Colby Shane Brownlee |
First Address | Fort Worth, TX 76179-7111 |
Second Address | Midland, TX 79701-3885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 30/08/2018 |