Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | M0700 | TX |
NPI | 1003862715 |
---|---|
Provider Name | Ms. Jacqueline Leticia Davis-Herr |
First Address | Flower Mound, TX 75028-1565 |
Second Address | Flower Mound, TX 75028-1565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 11/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
182734701 | (05) | TX |