Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | G8471 | TX |
N | 207V00000X | Obstetrician & Gynecologist | G8471 | TX |
NPI | 1265496996 |
---|---|
Provider Name | Diane M Twickler |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 17/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136080206 | (05) | TX |
136080207 | (05) | TX |
B27149 | (02) |