Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | S0280 | TX |
NPI | 1164740221 |
---|---|
Provider Name | Dr. Sara M. Edeiken |
First Address | Baytown, TX 77521-3158 |
Second Address | Baytown, TX 77521-3158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2010 |
Last Update Date | 09/08/2019 |