NPI age
19 years
Enumerated 2007-02-19
Across 1597 active pathology providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 192729501 | |
| 01 (TX) | 0050GW | BCBS PIN |
| 01 (TX) | M4261 | STATE LICENSE |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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