Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | R6389 | TX |
N | 208600000X | Surgeon | R6389 | TX |
Y | 2086X0206X | Surgical Oncologist | R6389 | TX |
NPI | 1144715384 |
---|---|
Provider Name | Maryam Elmi |
First Address | San Antonio, TX 78229 |
Second Address | San Antonio, TX 78229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2018 |
Last Update Date | 21/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
387011501 | (05) | TX |
387011502 | CSHCN (01) | TX |