Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | K0680 | TX |
NPI | 1033171103 |
---|---|
Provider Name | Sarah Cheriyan |
First Address | Lufkin, TX 75904 |
Second Address | Lufkin, TX 75904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 17/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029971101 | (05) | TX |
8CG306 | BCBS (01) | |
G20494 | (02) |