Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | N4391 | TX |
NPI | 1003011297 |
---|---|
Provider Name | Dr. Heidi Danielle Tomlinson |
First Address | Fort Worth, TX 76104-2122 |
Second Address | Fort Worth, TX 76104-2122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 20/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
211980201 | (05) | TX |