Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | K7754 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | K7754 | TX |
NPI | 1114916715 |
---|---|
Provider Name | Dr. Lesca Cherise Hadley |
First Address | Fort Worth, TX 76199-0335 |
Second Address | Fort Worth, TX 76104-4917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 13/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H47317 | (02) | TX |