NPI age
20 years
Enumerated 2005-07-08
Across 15966 active family medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | J3587 | STATE LICENSE |
| 05 (TX) | 136418406 | |
| 05 (TX) | 136418408 | |
| 01 | F65496 | UPIN # |
| 01 (TX) | 0002CF | BLUE CROSS ID |
| 05 (TX) | 136418401 | |
| 01 (TX) | 45D0937526 | CLIA |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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