Individual
TAM NGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6209 INDIANA AVE, LUBBOCK, TX 79413-5728
(281) 731-0305
Mailing address
1001 S GEORGE ST, YORK, PA 17403-3676
(717) 851-2427
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MT220436
PA
208D00000X
General Practice Physician
Primary
U6035
TX
Other
Enumeration date
05/15/2020
Last updated
01/10/2024
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