Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | K9358 | TX |
NPI | 1003818337 |
---|---|
Provider Name | Suzanne E Monday |
First Address | Greenville, TX 75404-8128 |
Second Address | Greenville, TX 75401-5635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 03/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
285695701 | (05) | TX |
8EY894 | BCBS (01) | TX |
G85165 | (02) | TX |
TXB111773 | PTAN (01) | TX |