Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G4701 | TX |
N | 207ND0900X | Dermatopathologist | G4701 | TX |
NPI | 1366556193 |
---|---|
Provider Name | Dr. Ramon Larrea Sanchez |
First Address | Galveston, TX 77550-4906 |
Second Address | Galveston, TX 77550-4906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 18/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070012339 | RAILROAD MEDICARE (01) | TX |
136906801 | (05) | TX |
C21523 | (02) | TX |