Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 15898 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | J7757 | TX |
NPI | 1013084169 |
---|---|
Provider Name | Harry Paul Casmedes |
First Address | Austin, TX 78731-6400 |
Second Address | Austin, TX 78749-1980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 25/09/2012 |