Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M0376 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | M0376 | TX |
NPI | 1104808765 |
---|---|
Provider Name | Dr. Suparna M Chhibber |
First Address | Houston, TX 77079-5309 |
Second Address | Houston, TX 77079-5309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 20/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I25204 | (02) | TX |