NPI age
20 years
Enumerated 2006-05-25
Across 3028 active surgery providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (CA) | C167473 | CA STATE MEDICAL LICENSE |
| 01 (TX) | H3833 | STATE MEDICAL LICENSE |
| 05 (TX) | 104970201 |
Solo or small practice. No other active providers share this practice address in NPPES.
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