Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 1055 | WI |
Y | 2084N0402X | Child Neurologist | L2120 | TX |
NPI | 1265442040 |
---|---|
Provider Name | Mrs. Mary O Baiyeri |
First Address | Grapevine, TX 76051-8113 |
Second Address | Grapevine, TX 76051-8113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 06/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
155673004 | (05) | TX |
174888101 | (05) | TX |
BB7324089 | DEA NUMBER (01) | TX |
I26641 | (02) | TX |