Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | R7836 | TX |
NPI | 1154718443 |
---|---|
Provider Name | Rory Nicolaides |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2015 |
Last Update Date | 17/11/2020 |