Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 73 | TX |
Y | 222Z00000X | Podiatrist | 73 | TX |
N | 224P00000X | Prosthetist | 73 | TX |
NPI | 1396983904 |
---|---|
Provider Name | Ms. Suzanne G O'connor |
First Address | Dallas, TX 75247-3631 |
Second Address | Dallas, TX 75247-3631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2009 |
Last Update Date | 29/08/2012 |