Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | P3516 | TX |
Y | 111NI0900X | Internist | P3516 | TX |
NPI | 1003041831 |
---|---|
Provider Name | Irene A Carrothers |
First Address | Mckinney, TX 75071-7822 |
Second Address | Longview, TX 75601-5580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2009 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3052300-01 | (05) | TX |
305230008 | (05) | TX |