Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | J5279 | TX |
N | 111NI0900X | Internist | J5279 | TX |
Y | 207RH0002X | Hospice and Palliative Medicine | J5279 | TX |
NPI | 1003906173 |
---|---|
Provider Name | Dr. Rosemary Chacko |
First Address | Fort Sam Houston, TX 78234-4504 |
Second Address | Fort Sam Houston, TX 78234-4504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1137176-01 | (05) | TX |
F96093 | (02) |