Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | K0838 | TX |
NPI | 1417965096 |
---|---|
Provider Name | Dr. Mallika Iyer |
First Address | The Woodlands, TX 77387-8877 |
Second Address | Conroe, TX 77304-2888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 22/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043533102 | (05) | TX |
8A4680 | BCBS (01) | TX |
F62082 | (02) | TX |
P00148033 | RAILROAD MEDICARE (01) | TX |