Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | M0469 | TX |
Y | 2084N0402X | Child Neurologist | M0469 | TX |
NPI | 1205916608 |
---|---|
Provider Name | Diana Lebron |
First Address | Amarillo, TX 79106-1708 |
Second Address | Amarillo, TX 79106-1786 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 12/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
167799901 | (05) | TX |
167799907 | (05) | TX |
167799908 | (05) | TX |
200625390 A | (05) | OK |
4267701 | (05) | NM |
G79114 | (02) |