Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | M0059 | TX |
N | 2086S0122X | Plastic and Reconstructive Surgery | M0059 | TX |
NPI | 1215276787 |
---|---|
Provider Name | Dr. Peter Vail Driscoll |
First Address | Austin, TX 78731-3341 |
Second Address | Austin, TX 78731-3341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2013 |
Last Update Date | 04/02/2013 |