Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | D6220 | TX |
NPI | 1043213721 |
---|---|
Provider Name | Dr. Sue E Young Knolle |
First Address | Austin, TX 78746-4305 |
Second Address | Austin, TX 78746-4305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 06/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043213721 | NPI (01) | TX |
1154432508 | GROUP NPI (01) | TX |
C23880 | MEDICARE UPIN NUMBER (02) | TX |
ZOOOL63V8 | MEDICAID NUMBER (05) | TX |