Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | L1746 | TX |
NPI | 1053308569 |
---|---|
Provider Name | Diane Marie Shirley - Davis |
First Address | Houston, TX 77064-1240 |
Second Address | Houston, TX 77070-4350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 09/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1101599 | BEECHSTREET (01) | TX |
142009301 | (05) | TX |
H32704 | (02) | TX |