Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | ME144492 | FL |
Y | 207L00000X | Anesthesiologist | T0220 | TX |
NPI | 1003264110 |
---|---|
Provider Name | Lisa Gu |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 09/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106777400 | (05) | FL |