Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | K8017 | TX |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | K8017 | TX |
NPI | 1346273034 |
---|---|
Provider Name | Dr. Muriel K Boreham |
First Address | Dallas, TX 75204 |
Second Address | Dallas, TX 75204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 19/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138577513 | (05) | TX |
138577514 | (05) | TX |
138577515 | (05) | TX |
138577516 | (05) | TX |
8P6748 | BCBS (01) | TX |
G97674 | (02) | |
P00862876 | (02) | TX |
TXB100118 | (02) | TX |