NPI age
19 years
Enumerated 2007-01-30
Across 2220 active physician assistant providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (KS) | 201108990A | |
| 01 (TX) | PA05064 | LICENSE |
| 01 (KS) | 003719365 | MEDICARE |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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