Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 7212 | TX |
NPI | 1477581007 |
---|---|
Provider Name | Dr. Ronald Duane Fielden II |
First Address | Canyon Lake, TX 78132-2280 |
Second Address | San Antonio, TX 78258-4624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 17/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U64935 | (02) | TX |