Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | K0485 | TX |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | K0485 | TX |
NPI | 1326197609 |
---|---|
Provider Name | Debra Jane Gummelt |
First Address | Pearland, TX 77584-7298 |
Second Address | Shenandoah, TX 77384-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 10/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037730106 | (05) | TX |
037730107 | (05) | TX |
G34248 | (02) |