Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1290916 | TX |
Y | 213ES0000X | Sports Medicine | 1290916 | TX |
NPI | 1437686300 |
---|---|
Provider Name | Mary M Wilkins |
First Address | Austin, TX 78705-1125 |
Second Address | Austin, TX 78705-1125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 22/05/2017 |