Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | G4583 | TX |
NPI | 1477516201 |
---|---|
Provider Name | Jane Franklin Goldthorn |
First Address | Lubbock, TX 79410 |
Second Address | Lubbock, TX 79410-1122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 21/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137323511 | (05) | TX |
B23056 | (02) |