Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | M6125 | TX |
NPI | 1053533026 |
---|---|
Provider Name | Dr. Mary A Evers |
First Address | Georgetown, TX 78626-7703 |
Second Address | Georgetown, TX 78626-7703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 23/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
192526501 | (05) | TX |