Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M0422 | TX |
NPI | 1003851676 |
---|---|
Provider Name | Dr. Astrid Gutsmann |
First Address | Allen, TX 75002-2854 |
Second Address | Allen, TX 75002-2854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0031NK | BCBS TX (01) | TX |
I53638 | (02) | TX |