Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | F9765 | TX |
Y | 207PE0004X | Emergency Medical Services | F9765 | TX |
NPI | 1174574933 |
---|---|
Provider Name | June Mabry |
First Address | Conroe, TX 77384-5049 |
Second Address | Navasota, TX 77868-3704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 27/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139641820 | (05) | TX |
E15045 | (02) | TX |