Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 049418 | CT |
Y | 207VX0201X | Gynecologic Oncologist | Q7907 | TX |
NPI | 1427016989 |
---|---|
Provider Name | Dr. Angela S Kueck |
First Address | Dallas, TX 75391-1230 |
Second Address | Austin, TX 78758-5444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 27/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1427016989 | (05) | CT |
357012901 | (05) | TX |
357012902 | (05) | TX |