Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | M7757 | TX |
N | 208600000X | Surgeon | M7757 | TX |
Y | 2086X0206X | Surgical Oncologist | M7757 | TX |
NPI | 1164685160 |
---|---|
Provider Name | Dr. Rebecca Lynn Wiatrek |
First Address | Dallas, TX 75391-1230 |
Second Address | Austin, TX 78758-5354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 09/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
302090105 | (05) | TX |
302090106 | (05) | TX |
P01626912 | RAILROAD MEDICARE (01) | TX |