Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 2141 | TX |
Y | 213ES0103X | Foot & Ankle Surgery | 2141 | TX |
N | 213ES0131X | Foot Surgery | 2141 | TX |
NPI | 1275504250 |
---|---|
Provider Name | Tonyka Alycia James |
First Address | Fort Worth, TX 76104-2100 |
Second Address | Fort Worth, TX 76104-2158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 09/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
193738501 | (05) | TX |
8N8359 | BLUE CROSS BLUE SHIELD (01) | TX |
P00342393 | MEDICARE RAILROAD (01) | TX |