Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | M3415 | TX |
NPI | 1053399477 |
---|---|
Provider Name | Jay L Viernes |
First Address | Austin, TX 78723-1142 |
Second Address | Austin, TX 78731-3146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000302315 | HMSA (01) | HI |
181242201 | (05) | TX |
181242202 | (05) | TX |
181242203 | (05) | TX |
P00378784 | (05) | TX |