Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | K8272 | TX |
NPI | 1992783393 |
---|---|
Provider Name | Dr. Stephen George Krzeminski |
First Address | Granbury, TX 76048-5641 |
Second Address | Granbury, TX 76048-5641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G90581 | (02) | TX |