NPI age
20 years
Enumerated 2005-11-16
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 00PN70 | BLUE CROSS BLUE SHIELD |
| 05 (TX) | 120163404 | |
| 01 (TX) | 00PN70 | BLUE CROSS/BLUE SHIELD TX |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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