Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | R5755 | TX |
NPI | 1417186453 |
---|---|
Provider Name | Alice King |
First Address | Houston, TX 77021-2039 |
Second Address | Houston, TX 77030-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2009 |
Last Update Date | 20/04/2018 |