Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | S3656 | TX |
NPI | 1346777364 |
---|---|
Provider Name | Jamie Eller |
First Address | Conroe, TX 77304-3320 |
Second Address | Conroe, TX 77304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 20/01/2021 |