Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 595 | TX |
NPI | 1376943688 |
---|---|
Provider Name | Ron Desmond Dominy |
First Address | Round Rock, TX 78681-5052 |
Second Address | Round Rock, TX 78681-5052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2014 |
Last Update Date | 25/08/2014 |