Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | Q5100 | TX |
NPI | 1093072548 |
---|---|
Provider Name | Li Song |
First Address | Dallas, TX 75284-7208 |
Second Address | Dallas, TX 75390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2012 |
Last Update Date | 30/05/2019 |