Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | F7208 | TX |
NPI | 1033171582 |
---|---|
Provider Name | Dr. Patricia J. Sulak |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807650 | BLUE SHIELD (01) | TX |
B26772 | (02) | TX |