Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D12740 | TX |
NPI | 1013061902 |
---|---|
Provider Name | Ronald Dee Horne |
First Address | Austin, TX 78746-7424 |
Second Address | Austin, TX 78756-3312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T13915 | (02) | TX |