Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | D6609 | TX |
NPI | 1538165022 |
---|---|
Provider Name | Theresa C. Queng |
First Address | Bellaire, TX 77401-4526 |
Second Address | Bellaire, TX 77401-4526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 23/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B25714 | (02) | TX |