Individual
MIA IVOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3601 4TH ST, LUBBOCK, TX 79430-0002
(806) 743-1810
Mailing address
3601 4TH ST, LUBBOCK, TX 79430-0002
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
746643
TX
Other
Enumeration date
05/26/2022
Last updated
05/26/2022
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