Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | H2723 | TX |
N | 2086X0206X | Surgical Oncologist | H2723 | TX |
NPI | 1386647048 |
---|---|
Provider Name | Dr. Mayme Richie-Gillespie |
First Address | Fort Worth, TX 76126-0979 |
Second Address | Fort Worth, TX 76104-7300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 09/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138940505 | (05) | TX |
E99874 | (02) | TX |
U41H | BCBS (01) | TX |