Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 1456 | TX |
NPI | 1013952514 |
---|---|
Provider Name | Dora Eda Achille |
First Address | Flower Mound, TX 75022-2718 |
Second Address | Flower Mound, TX 75022-2718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U89788 | (02) | TX |