Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 18581 | TX |
NPI | 1336207604 |
---|---|
Provider Name | Dr. Stephen Bradley Bookmyer |
First Address | Round Rock, TX 78681-4010 |
Second Address | Round Rock, TX 78681-4010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |