Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | E1242 | TX |
NPI | 1013962109 |
---|---|
Provider Name | Gene P Ream |
First Address | Euless, TX 76040-3739 |
Second Address | Euless, TX 76040-3739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 28/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C20912 | (02) | TX |