Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | F6809 | TX |
NPI | 1003973330 |
---|---|
Provider Name | Mrs. Karen Kaden Andre |
First Address | Greenville, TX 75401 |
Second Address | Greenville, TX 75401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 07/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128044804 | (05) | TX |
B23807 | (02) | TX |