Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 31058 | TX |
Y | 213EG0000X | General Practice | 31058 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 31058 | TX |
NPI | 1114302783 |
---|---|
Provider Name | Abigail Sellers |
First Address | San Antonio, TX 78220-1013 |
Second Address | San Antonio, TX 78220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2015 |
Last Update Date | 15/06/2018 |