Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | K3186 | TX |
NPI | 1245228063 |
---|---|
Provider Name | Dr. Mary Elizabeth Fleischli |
First Address | Dallas, TX 75230-7891 |
Second Address | Dallas, TX 75230-7891 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 12/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G49640 | (02) | TX |