NPI age
20 years
Enumerated 2005-08-26
Across 15966 active family medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | Y0048390 | STATE DPS LICENSE |
| 01 (TX) | G1816 | STATE LICENSE |
| 05 (TX) | 156968301 | |
| 01 (TX) | TAX ID | 741903407 |
Part of a multi-provider practice. 99 other active providers share this practice address in NPPES.
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