Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | PA13478 | TX |
NPI | 1073148300 |
---|---|
Provider Name | Isabel Mantooth |
First Address | Pflugerville, TX 78660-6019 |
Second Address | Austin, TX 78705-2858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2020 |
Last Update Date | 06/03/2020 |