Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | R8151 | TX |
NPI | 1013322858 |
---|---|
Provider Name | Sam Awan |
First Address | Dallas, TX 75230-5826 |
Second Address | Plano, TX 75024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 03/06/2019 |