Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | BP1-0038005 | TX |
NPI | 1144530676 |
---|---|
Provider Name | Shelby R Lies |
First Address | Dallas, TX 75390-9132 |
Second Address | Dallas, TX 75390-9132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2010 |
Last Update Date | 22/06/2016 |