Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | K6132 | TX |
NPI | 1033391362 |
---|---|
Provider Name | Shirley Mathew |
First Address | Houston, TX 77082-2420 |
Second Address | Houston, TX 77082-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 23/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
096457901 | (05) | TX |
G39713 | (02) |