NPI age
20 years
Enumerated 2006-05-01
Across 548 active surgery providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | P9255 | TX LICENSE |
| 01 (KY) | 35863 | STATE LICENSE NUMBER |
| 01 (IN) | 01062143A | STATE MEDICAL LICENSE |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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