Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | J5262 | TX |
NPI | 1003849431 |
---|---|
Provider Name | Carol Lynn Ziebert |
First Address | Austin, TX 78705-1923 |
Second Address | Austin, TX 78705-1923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 14/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103413401 | (05) | TX |
F69842 | (02) | TX |