Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1508 | TX |
Y | 222Z00000X | Podiatrist | 1508 | TX |
NPI | 1063779486 |
---|---|
Provider Name | Jillian M Swazey |
First Address | Fort Worth, TX 76199-1383 |
Second Address | Fort Worth, TX 76110-1349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 23/04/2012 |