Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | M1235 | TX |
NPI | 1174553655 |
---|---|
Provider Name | Ricardo Meade |
First Address | Dallas, TX 75231-5927 |
Second Address | Dallas, TX 75231-5927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 06/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
174223104 | (05) | TX |
I31826 | (02) | TX |