| NPI | 1053334359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACIE SLATTERY Administrator 979-836-6153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX E2546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G5283) |
| 207R00000X Internal Medicine (Licence: TX E8650) | |
| 207R00000X Internal Medicine (Licence: TX F4241) | |
| 207R00000X Internal Medicine (Licence: TX M 8802) | |
| 207V00000X Obstetrics & Gynecology (Licence: TX H0692) | |
| 207V00000X Obstetrics & Gynecology (Licence: TX M4810) | |
| 208000000X Pediatrics (Licence: TX F3730) | |
| 208000000X Pediatrics (Licence: TX K6753) | |
| 208000000X Pediatrics (Licence: TX N1685) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2009-10-19 |