Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | M0482 | TX |
NPI | 1184716102 |
---|---|
Provider Name | Jodi Stengem Markus |
First Address | Bellaire, TX 77401-5809 |
Second Address | Houston, TX 77030-2761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 24/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136324401 | (05) | TX |
I45660 | (02) | TX |