Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | Q4234 | TX |
N | 208D00000X | General Practice Physician | 12650I | PR |
NPI | 1003120965 |
---|---|
Provider Name | Dr. Ana Maria Pagan |
First Address | Laredo, TX 78041-5443 |
Second Address | Laredo, TX 78041-5443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2010 |
Last Update Date | 05/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q4234 | TEXAS LICENSE NUMBER (01) | TX |