Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G3791 | TX |
NPI | 1033165980 |
---|---|
Provider Name | Dr. Roger Glynn Skiles |
First Address | Dallas, TX 75284-4658 |
Second Address | Marble Falls, TX 78654-8606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 04/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D50881 | (02) | TX |