Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 891413 | TX |
NPI | 1629660790 |
---|---|
Provider Name | Emily Marie Sluss |
First Address | Fort Worth, TX 76135-7023 |
Second Address | Fort Worth, TX 76135-7023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2021 |
Last Update Date | 09/02/2021 |