Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | J2219 | TX |
NPI | 1043387475 |
---|---|
Provider Name | Mrs. Sudha Lakshmi Mootha |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
089984103 | (05) | TX |
G77578 | (02) |