Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 10667 | TX |
Y | 111NN0400X | Neurology | 10667 | TX |
NPI | 1265639462 |
---|---|
Provider Name | Dr. Ruben St Laurent |
First Address | Flower Mound, TX 75028-2744 |
Second Address | Flower Mound, TX 75028-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 27/02/2018 |