Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99286 | TX |
NPI | 1083151963 |
---|---|
Provider Name | Melek Speros |
First Address | Austin, TX 78747-2718 |
Second Address | Austin, TX 78747-2718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2017 |
Last Update Date | 30/01/2017 |