Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | M6674 | TX |
NPI | 1023227717 |
---|---|
Provider Name | Dr. Candice Pimlapah Jantz |
First Address | Dallas, TX 75247-4228 |
Second Address | Plano, TX 75093-8122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1868812-03 | (05) | TX |
8CV781 | BCBS (01) | TX |