NPI age
18 years
Enumerated 2007-06-29
Across 15966 active family medicine providers in Texas.
2 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 00Z738 | MEDICARE GROUP PIN |
| 05 (TX) | 197261401 | |
| 01 (TX) | 45D1093868 | CLIA # |
| 01 | 1639165731 | MCRE INDV NPI # |
| 01 (KY) | 38179 | LICENSE NUMBER |
| 05 (TX) | 1003013350 | |
| 01 (TX) | N0337 | TEXAS LICENSE |
| 01 (TX) | 197259801 | MEDICAID GRP # |
| 05 (KY) | 64071715 |
Multi-provider organization. 2 individual providers on file at this primary address.
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