Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 31511 | TX |
NPI | 1134590474 |
---|---|
Provider Name | Juan P Ramirez |
First Address | Round Rock, TX 78665-5026 |
Second Address | Round Rock, TX 78665-5026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2015 |
Last Update Date | 13/10/2015 |