Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 14909 | TX |
NPI | 1003008079 |
---|---|
Provider Name | Dr. Ronald J. Carr |
First Address | Odessa, TX 79762-4882 |
Second Address | Odessa, TX 79762-4882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 14/08/2007 |