Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | J8475 | TX |
NPI | 1124052121 |
---|---|
Provider Name | Dr. Sandra Zoe Brothers |
First Address | Dallas, TX 75246-1713 |
Second Address | Dallas, TX 75246-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 19/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
143857402 | (05) | TX |
160052816 | RAIL ROAD MEDICARE (01) | TX |
8AJ518 | BC/BS SOLO IDENTIFIER (01) | TX |
G70802 | (02) | TX |