Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | M0145 | TX |
NPI | 1003975525 |
---|---|
Provider Name | Dr. Gail S Lebovic |
First Address | Dallas, TX 75230-2223 |
Second Address | Dallas, TX 75230-2223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8M5535 | BLUE CROSS (01) | TX |
F25520 | (02) | TX |