Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | OS016537 | PA |
N | 208600000X | Surgeon | OS016537 | PA |
N | 208200000X | Surgeon | Q0374 | TX |
N | 208600000X | Surgeon | Q0374 | TX |
Y | 2086X0206X | Surgical Oncologist | Q0374 | TX |
NPI | 1003257957 |
---|---|
Provider Name | Amelia Brooke Tower |
First Address | Fort Worth, TX 76104-2810 |
Second Address | Fort Worth, TX 76104-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2013 |
Last Update Date | 25/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
335786501 | (05) | TX |
335786503 | (05) | TX |
8EJ304 | BCBS (01) | TX |