Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | PA14271 | TX |
NPI | 1295326882 |
---|---|
Provider Name | Sarah Bock |
First Address | Richardson, TX 75082-2409 |
Second Address | San Antonio, TX 78240-1512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2021 |
Last Update Date | 27/01/2021 |