NPI age
19 years
Enumerated 2006-08-17
Across 15966 active family medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (MO) | 1194838409 | |
| 01 (MO) | P00724821 | RAILROAD MEDICARE |
| 01 | 11820416 | CAQH PROVIDER # |
| 01 | 431560263 | TRICARE WEST |
Solo or small practice. No other active providers share this practice address in NPPES.
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