Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD038210 | DC |
N | 207N00000X | Dermatologist | ME106298 | FL |
Y | 207N00000X | Dermatologist | N2335 | TX |
N | 207ND0101X | MOHS-Micrographic Surgeon | N2335 | TX |
NPI | 1073773867 |
---|---|
Provider Name | Molly Mae Warthan |
First Address | Fort Worth, TX 76109-4131 |
Second Address | Fort Worth, TX 76109-4131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2008 |
Last Update Date | 23/09/2020 |