Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0101271085 | VA |
NPI | 1003377599 |
---|---|
Provider Name | Sarah Mcdonald |
First Address | Jbsa Lackland, TX 78236-9908 |
Second Address | Jbsa Lackland, TX 78236-9908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 08/03/2021 |