Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 69259 | GA |
NPI | 1952568370 |
---|---|
Provider Name | Dr. Danny Jose Soares |
First Address | Dunwoody, GA 30338-7909 |
Second Address | Atlanta, GA 30338-6408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 25/07/2013 |