NPI age
20 years
Enumerated 2005-08-04
Across 223 active surgery providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 166113401 | |
| 01 (TX) | 00Z788 | MEDICARE GROUP PTAN |
| 01 (TX) | 82LG | BLUE CROSS-BLUE SHIELD |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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