Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | N3665 | TX |
NPI | 1063616621 |
---|---|
Provider Name | Dr. Jaya Kanniakonil George-Abraham |
First Address | Austin, TX 78723-3077 |
Second Address | Austin, TX 78723-3077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 08/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288021301 | (05) | TX |