Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | K1693 | TX |
N | 2080P0201X | Pediatric Allergist | K1693 | TX |
NPI | 1740288729 |
---|---|
Provider Name | Dr. Grace P Tamesis |
First Address | Round Rock, TX 78681-3574 |
Second Address | Round Rock, TX 78681-3574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 27/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
79878245 | (05) | CO |