Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G7201 | TX |
NPI | 1013964105 |
---|---|
Provider Name | Madeleine Duvic |
First Address | Houston, TX 77216-1088 |
Second Address | Houston, TX 77030-1312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 03/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132116801 | CSHCN (01) | TX |
132116805 | (05) | TX |
87X442 | BCBCTX (01) | TX |
B22413 | (02) |