NPI age
20 years
Enumerated 2006-05-15
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | H2855 | STATE LICENSE |
| 05 (TX) | 122815701 | |
| 01 (TX) | 88414Z | BLUE CROSS/BLUE SHIELD |
Part of a multi-provider practice. 107 other active providers share this practice address in NPPES.
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