Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | PA12145 | TX |
NPI | 1023592425 |
---|---|
Provider Name | Samantha Blake Foley |
First Address | Dallas, TX 75390-7201 |
Second Address | Dallas, TX 75235-7708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 01/10/2020 |