Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | Q4669 | TX |
NPI | 1053630582 |
---|---|
Provider Name | Ms. Heidi Belle Prather |
First Address | Austin, TX 78746-4721 |
Second Address | Austin, TX 78746-4721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 06/02/2019 |