Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | S7086 | TX |
NPI | 1841801594 |
---|---|
Provider Name | Dr. Gavin John Le Nobel |
First Address | Tomball, TX 77377 |
Second Address | Tomball, TX 77377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2020 |
Last Update Date | 18/06/2021 |