Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | S5440 | TX |
NPI | 1194042689 |
---|---|
Provider Name | Dr. Amy Ann Mrazek |
First Address | Dallas, TX 75265-6944 |
Second Address | Galveston, TX 77555-0527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2010 |
Last Update Date | 06/01/2022 |