Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | D2893 | TX |
N | 207KA0200X | Allergist | D2893 | TX |
NPI | 1033154729 |
---|---|
Provider Name | Gladys C. Keene |
First Address | Laredo, TX 78045 |
Second Address | Laredo, TX 78041-6417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 19/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
121446201 | (05) | TX |
121446205 | (05) | TX |
C17758 | (02) | TX |