Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 34322 | TX |
Y | 213EG0000X | General Practice | 34322 | TX |
NPI | 1003393414 |
---|---|
Provider Name | Deana Victoria Smalls |
First Address | Austin, TX 78728-4381 |
Second Address | Austin, TX 78728-4381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2018 |
Last Update Date | 27/07/2018 |