Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | K2132 | TX |
NPI | 1164502597 |
---|---|
Provider Name | Heidi Russell |
First Address | Houston, TX 77030-2316 |
Second Address | Houston, TX 77030-2316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 13/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037650101 | (05) | TX |
H29272 | (02) |