Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | J7368 | TX |
N | 207ND0101X | MOHS-Micrographic Surgeon | J7368 | TX |
NPI | 1215026232 |
---|---|
Provider Name | Russell Scott Rowe |
First Address | Belton, TX 76513-1013 |
Second Address | Gatesville, TX 76528-1024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 01/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200072318 | (05) | MO |
VAD000 | (02) | KY |