Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | PA11398 | TX |
N | 208600000X | Surgeon | PA11398 | TX |
NPI | 1003339649 |
---|---|
Provider Name | Sally Matika |
First Address | Austin, TX 78731-3100 |
Second Address | Austin, TX 78731-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 16/02/2018 |