Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | P9734 | TX |
NPI | 1063711323 |
---|---|
Provider Name | Mrs. Tricia Blair Sias |
First Address | Highland Village, TX 75077-3327 |
Second Address | Highland Village, TX 75077-3327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2011 |
Last Update Date | 20/12/2018 |