Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | BP10075621 | TX |
NPI | 1003480054 |
---|---|
Provider Name | Sara Al Dogom |
First Address | Lubbock, TX 79416-5424 |
Second Address | Lubbock, TX 79430-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2021 |
Last Update Date | 14/05/2021 |