Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 20416 | TX |
NPI | 1023034675 |
---|---|
Provider Name | Dr. Gracie Sturdivant |
First Address | Mcallen, TX 78501-4145 |
Second Address | Mcallen, TX 78501-4145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 08/07/2007 |