NPI | 1083239537 |
---|---|
Former Name | SHELBY R LACEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02007102A) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10072222) |
207R00000X Internal Medicine (Licence: IN 02007102B) | |
Enumeration Date | 2020-06-10 |
Last Update Date | 2024-08-19 |