Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | G9662 | TX |
NPI | 1093765596 |
---|---|
Provider Name | Mary Ann Skiba |
First Address | Fort Worth, TX 76104-4611 |
Second Address | Fort Worth, TX 76104-4611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 21/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1283509-06 | (05) | TX |
1283509-07 | (05) | TX |
A67662 | (02) | TX |