Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 677 | NE |
N | 207Q00000X | Family Doctor | R877 | AZ |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 677 | NE |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | Q8681 | TX |
NPI | 1134305956 |
---|---|
Provider Name | Asha Ganpat Wurdeman |
First Address | Sugar Land, TX 77479-2329 |
Second Address | Sugar Land, TX 77479-2329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2008 |
Last Update Date | 18/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q8681 | MEDICAL LICENSE (01) | TX |
R877 | TRAINING PERMIT (01) | AZ |