Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MT187105 | PA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | Q2102 | TX |
NPI | 1114169810 |
---|---|
Provider Name | Dr. Karla Bermudez Wagner |
First Address | Houston, TX 77030 |
Second Address | Houston, TX 77030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2009 |
Last Update Date | 13/06/2017 |