Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | Q6050 | TX |
N | 2080A0000X | Adolescent Medicine | 21756 | MS |
NPI | 1225298011 |
---|---|
Provider Name | Kofoworola Mariam Kuboye |
First Address | Mckinney, TX 75071-5511 |
Second Address | Mckinney, TX 75071-5511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2008 |
Last Update Date | 21/10/2019 |