Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | F8093 | TX |
NPI | 1124021373 |
---|---|
Provider Name | Dr. Randall C Dunn |
First Address | Houston, TX 77054-2949 |
Second Address | Houston, TX 77054-2949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83044G | BLUE CROSS & BLUE SHIELD (01) | TX |
E35377 | (02) | TX |