Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | J8313 | TX |
NPI | 1144260837 |
---|---|
Provider Name | Deborah Mccollum |
First Address | Dallas, TX 75284-0026 |
Second Address | Amarillo, TX 79106-1755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 27/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0049HR | BLUECROSS/BLUESHIELD (01) | TX |
G08150 | (02) | TX |