Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | AP114677 | TX |
NPI | 1316427420 |
---|---|
Provider Name | Angela Dee Killeen-Hirschhorn |
First Address | Dallas, TX 75230-6140 |
Second Address | Dallas, TX 75230-6140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |