Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G8915 | TX |
NPI | 1265415780 |
---|---|
Provider Name | Becky L Mcgraw-Wall |
First Address | Sugar Land, TX 77478-3842 |
Second Address | Houston, TX 77074-1829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 21/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
166659601 | (05) | TX |
E56006 | (02) | TX |
TXB166198 | MEDICARE - GROUP (01) | TX |