NPI age
20 years
Enumerated 2005-09-02
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 8V8610 | BCBS |
| 05 (TX) | 1421711-01 | |
| 05 (OK) | 200032370A | |
| 05 (LA) | 1756474 |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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