Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | K0039 | TX |
NPI | 1760593883 |
---|---|
Provider Name | Melissa J Garretson |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G30097 | (02) |