Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1784 | TX |
Y | 222Z00000X | Podiatrist | 1784 | TX |
N | 224P00000X | Prosthetist | 1784 | TX |
NPI | 1144723560 |
---|---|
Provider Name | Whitney Brandon |
First Address | Abilene, TX 79605-4603 |
Second Address | San Angelo, TX 76904-5129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2018 |
Last Update Date | 12/03/2018 |