Dr. Maryse Emmerencia Bakouetila, MD
Family Medicine in Irving, TX. Individual provider (NPI-1).
NPI number1871084632
StatusActive
Last updated in NPPESNov 17, 2021
Details
- NPI
- 1871084632
- Entity type
- Individual (NPI-1)
- Name
- Dr. Maryse Emmerencia Bakouetila
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 28, 2018
- Certification date
- Nov 17, 2021
- Last updated
- Nov 17, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | T3586 | TX | Yes |
Practice location
2021 N Macarthur Blvd Ste 350Irving, TX 75061-2217
Phone 972-817-1600
Mailing address
10902 Shettleston DrRichmond, TX 77407-2809
Phone 936-649-2520
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