Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | E6968 | TX |
NPI | 1073520250 |
---|---|
Provider Name | Susan Jane Taylor |
First Address | Del Rio, TX 78841-1315 |
Second Address | Del Rio, TX 78840-3627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1225260 (07) | (05) | TX |
8P5870 | BCBS INDIVIDUAL NUMBER (01) | TX |
D97778 | (02) | TX |
P00175170 | RR MEDICARE INDIVIDUAL # (01) | TX |