NPI age
19 years
Enumerated 2006-10-02
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 760191917 | TAX ID |
| 05 (TX) | 114356202 | |
| 01 (TX) | 00QG37 | BCBS |
| 01 (TX) | 1043401193 | GROUP |
| 01 (TX) | 1174616619 | BCBS |
Part of a multi-provider practice. 42 other active providers share this practice address in NPPES.
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