Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 1059033 | TX |
NPI | 1164180477 |
---|---|
Provider Name | Jordan Ashley Essenburg |
First Address | Dallas, TX 75219-4976 |
Second Address | Dallas, TX 75251-3124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2021 |
Last Update Date | 03/12/2021 |