Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | M4767 | TX |
NPI | 1326120734 |
---|---|
Provider Name | Angela Dawn Earhart |
First Address | Kingwood, TX 77339-4412 |
Second Address | Kingwood, TX 77339-4412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 14/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
185571006 | (05) | TX |
8BZ693 | BLUE CROSS BLUE SHIELD (01) | TX |