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Individual
NIDA NISAR
Active
Individual
NIDA NISAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
3102
TX
213ES0103X
Foot & Ankle Surgery Podiatrist
3102
TX
Other
Enumeration date
05/31/2018
Last updated
03/03/2025
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