Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | M1062 | TX |
NPI | 1124059027 |
---|---|
Provider Name | Libby Crenshaw George |
First Address | Spring, TX 77379-2519 |
Second Address | Houston, TX 77090-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 20/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177041404 | (05) | TX |
177041405 | CSHCN (01) | TX |
8U5761 | BCBS (01) | TX |
I25505 | (02) |