Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | DO721 | TX |
N | 207VX0000X | Obstetrician | D0721 | TX |
NPI | 1336567387 |
---|---|
Provider Name | Ron Paul |
First Address | Lake Jackson, TX 77566-3806 |
Second Address | Lake Jackson, TX 77566-3806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2014 |
Last Update Date | 06/04/2014 |