Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | N6931 | TX |
NPI | 1356589204 |
---|---|
Provider Name | Dr. Gunjan M Modi |
First Address | Plano, TX 75093-8046 |
Second Address | Plano, TX 75093-8046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2009 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
301160YTXP | (02) | TX |