Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 20448 | TX |
Y | 213EG0000X | General Practice | 20448 | TX |
NPI | 1003857442 |
---|---|
Provider Name | Dr. Susan D. Jolliff |
First Address | Brady, TX 76825-6936 |
Second Address | Brady, TX 76825-6936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 03/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164258901 | (05) | TX |
B20448 | CHIPS (01) | TX |