Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 2012-00371 | NC |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | P4782 | TX |
NPI | 1053594515 |
---|---|
Provider Name | Dr. Kristin Kucera Marcum |
First Address | Houston, TX 77025-1003 |
Second Address | Houston, TX 77025-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2007 |
Last Update Date | 10/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5920418 | (05) | NC |