Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30825 | TX |
NPI | 1023244340 |
---|---|
Provider Name | Dr. Jay Tyler Rasmussen |
First Address | West Lake Hills, TX 78746-6465 |
Second Address | West Lake Hills, TX 78746-6465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2009 |
Last Update Date | 27/08/2016 |