Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | TX12118 | TX |
NPI | 1023035458 |
---|---|
Provider Name | Robert Earl Russell Hawley |
First Address | Abilene, TX 79605 |
Second Address | Abilene, TX 79605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TX12118 | ST BOARD OF DENTAL EXAMIN (01) | TX |