NPI age
19 years
Enumerated 2006-11-17
Across 935 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 147296102 | |
| 01 | 8U0684 | OLD BLUE CROSS # |
| 01 | 743009528 | GROUP TAX ID |
| 01 | 8X7501 | NEW BLUE CROSS # |
Part of a multi-provider practice. 107 other active providers share this practice address in NPPES.
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