Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | BP1-0036594 | TX |
N | 208600000X | Surgeon | BP1-0036594 | TX |
Y | 208200000X | Surgeon | Q0571 | TX |
Y | 208600000X | Surgeon | Q0571 | TX |
NPI | 1003131012 |
---|---|
Provider Name | Julie Mckenzie Sprunt |
First Address | Dallas, TX 75391-1230 |
Second Address | Austin, TX 78705-1166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2010 |
Last Update Date | 11/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
360213801 | (05) | TX |
360213802 | (05) | TX |