Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | 01067919A | IN |
Y | 2080N0001X | Neonatal-Perinatal Doctor | R6791 | TX |
NPI | 1013174226 |
---|---|
Provider Name | Gayle Denise Haischer-Rollo |
First Address | San Antonio, TX 78219 |
Second Address | Lackland Afb, TX 78236-9908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2008 |
Last Update Date | 09/12/2021 |