Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | M5434 | TX |
NPI | 1013043744 |
---|---|
Provider Name | Emily Nell Pavlik |
First Address | San Antonio, TX 78253-5692 |
Second Address | Lackland A F B, TX 78236-9907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 16/07/2009 |