Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | N9533 | TX |
N | 207YS0123X | Facial Plastic Surgeon | N9533 | TX |
NPI | 1417168345 |
---|---|
Provider Name | Mark O Dammert |
First Address | Kyle, TX 78640-6178 |
Second Address | Kyle, TX 78640-6178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 06/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288309202 | (05) | TX |
288309203 | (05) | TX |
8DY645 | BCBS (01) | TX |