Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A113333 | CA |
N | 207N00000X | Dermatologist | R2876 | TX |
Y | 207ND0101X | MOHS-Micrographic Surgeon | R2876 | TX |
N | 207NP0225X | Pediatric Dermatologist | A113333 | CA |
N | 207NS0135X | Procedural Dermatology | R2876 | TX |
NPI | 1033437835 |
---|---|
Provider Name | Stanley Tyler Hollmig |
First Address | Austin, TX 78712-1765 |
Second Address | Austin, TX 78712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 19/11/2019 |