Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 45906 | AZ |
NPI | 1881803450 |
---|---|
Provider Name | Dr. Jared Mckean Theler |
First Address | Fort Sam Houston, TX 78234-4501 |
Second Address | Fort Sam Houston, TX 78234-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 26/09/2013 |