NPI age
20 years
Enumerated 2005-09-20
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | M2487 | LIC NO. |
| 01 (TX) | 1417006735 | GROUP NPI |
| 01 (TX) | 20-3418877 | TAX ID |
| 05 (TX) | 178296301 | |
| 05 (TX) | 178296302 | |
| 05 (TX) | 178297101 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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