Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | Q9500 | TX |
NPI | 1083916415 |
---|---|
Provider Name | Regina Rodman |
First Address | Houston, TX 77006-2033 |
Second Address | Galveston, TX 77555-5302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2010 |
Last Update Date | 10/06/2019 |