Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D10859 | TX |
NPI | 1689765315 |
---|---|
Provider Name | Dr. Richard Travis Tiner |
First Address | Garland, TX 75041-3764 |
Second Address | Garland, TX 75041-3764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T16301 | (02) | TX |