Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | D2930 | TX |
NPI | 1235198912 |
---|---|
Provider Name | Dr. George W. Brasher |
First Address | Dallas, TX 75284-7408 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 10/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807287 | BLUE SHIELD (01) | TX |
D47984 | (02) | TX |