Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | C8254 | TX |
N | 207YP0228X | Pediatric Otolaryngology | C8254 | TX |
N | 207YS0123X | Facial Plastic Surgeon | C8254 | TX |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | C8254 | TX |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | C8254 | TX |
NPI | 1972588481 |
---|---|
Provider Name | Dr. Juan Rayner Dickey |
First Address | Houston, TX 77063-2100 |
Second Address | Houston, TX 77063-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 26/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C15247 | (02) | TX |