Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | AG11200097 | TX |
NPI | 1174113112 |
---|---|
Provider Name | Lynette Scott |
First Address | Bellaire, TX 77401-2936 |
Second Address | Bellaire, TX 77401-2928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2021 |
Last Update Date | 23/01/2021 |