Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | S9648 | TX |
Y | 207ND0101X | MOHS-Micrographic Surgeon | S9648 | TX |
NPI | 1306208665 |
---|---|
Provider Name | Mr. Jeremiah Au |
First Address | Pearland, TX 77584-3922 |
Second Address | Katy, TX 77450-2448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 23/03/2021 |