Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | R6641 | TX |
NPI | 1164819975 |
---|---|
Provider Name | Shelease O'bryant |
First Address | Houston, TX 77030-2358 |
Second Address | Houston, TX 77030-2358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 24/12/2018 |