Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0208X | Pediatric Infectious Diseases | 0101059072 | VA |
Y | 2080P0208X | Pediatric Infectious Diseases | M8437 | TX |
NPI | 1144412917 |
---|---|
Provider Name | Susan Wootton |
First Address | Houston, TX 77216-1088 |
Second Address | Houston, TX 77030-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 14/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
192014201 | (05) | TX |
192014202 | CSHCN (01) | TX |
8X7055 | BCBS (01) | TX |