Individual
BRANDON LOUIS SOUKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7450 HOLLY HILL DR APT 104, DALLAS, TX 75231-5321
(254) 722-9724
Mailing address
7450 HOLLY HILL DR APT 104, DALLAS, TX 75231-5321
(254) 722-9724
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
686187
TX
Other
Enumeration date
11/20/2018
Last updated
11/20/2018
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