Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | F1535 | TX |
NPI | 1255453288 |
---|---|
Provider Name | Dr. Marybeth Ezaki |
First Address | Dallas, TX 75219-3924 |
Second Address | Dallas, TX 75219-3924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 09/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C15545 | (02) |