Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0822 | TX |
N | 222Z00000X | Podiatrist | 0822 | TX |
Y | 213EP1101X | Primary Podiatric Medicine | 0822 | TX |
NPI | 1386642759 |
---|---|
Provider Name | Dr. Karen Wasserman |
First Address | Dallas, TX 75230-2772 |
Second Address | Dallas, TX 75230-2772 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 23/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0822 | TX LICENSE (01) | TX |
2654990001 | PTAN (01) | |
T16495 | (02) | TX |