Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | Q6655 | TX |
NPI | 1023374519 |
---|---|
Provider Name | Patrick Henry Mcdonough |
First Address | Dallas, TX 75214-2697 |
Second Address | Dallas, TX 75214-2697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 26/08/2016 |