| NPI | 1275880379 |
|---|---|
| Former Name | JODY MAE COLEMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P4455) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD441840) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2014-07-14 |