Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | J8101 | TX |
NPI | 1578523486 |
---|---|
Provider Name | Shobha S Rao |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 07/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117536604 | (05) | TX |
117536606 | (05) | TX |
F92669 | (02) |