Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | P1391 | TX |
NPI | 1255535829 |
---|---|
Provider Name | Dr. Karen Quintavell Radcliffe |
First Address | League City, TX 77573 |
Second Address | League City, TX 77573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 04/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3879138231 | MYUTMB 3879138231-COMMERCIAL NUMBER (01) |