Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 042847 | NY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 37107 | TX |
NPI | 1275619124 |
---|---|
Provider Name | Dr. Rawle Fabian Philbert |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-5504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 17/11/2021 |