NPI age
19 years
Enumerated 2006-11-29
Across 351 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 | 74-2205260 | TAX IDENTIFICATION NUMBER |
| 01 (NM) | U3992 | NEW MEXICO MEDICAID |
| 05 (TX) | 132033501 | |
| 01 (TX) | RH04 | BLUE CROSS BLUE SHIELD |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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