Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 661686 | TX |
NPI | 1033691746 |
---|---|
Provider Name | Malcolm Duncan |
First Address | Austin, TX 78723-1411 |
Second Address | Austin, TX 78723-1411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 30/08/2018 |