Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 33940 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 33940 | TX |
NPI | 1548510332 |
---|---|
Provider Name | Dr. Hisham A. Marwan |
First Address | Galveston, TX 77555-0531 |
Second Address | Miami, FL 33136-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2012 |
Last Update Date | 15/07/2019 |