Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2040129 | TX |
NPI | 1063043917 |
---|---|
Provider Name | Susan Croll Zegub |
First Address | Lampasas, TX 76550-0028 |
Second Address | Lampasas, TX 76550-1105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2020 |
Last Update Date | 29/01/2020 |