Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | G9465 | TX |
NPI | 1073611950 |
---|---|
Provider Name | Bonnie S. Glisson |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 19/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110059244 | RR MEDICARE (01) | TX |
36706201 | (05) | TX |
800875 | BCBS (01) | TX |
B23014 | (02) |