Individual
QI CAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5959 HARRY HINES BLVD, DALLAS, TX 75235-6234
(214) 645-5670
Mailing address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7201
(214) 645-5670
(252) 744-1889
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
R5706
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/14/2013
Last updated
05/27/2021
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