NPI age
19 years
Enumerated 2006-09-15
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 044422603 | MEDICAID EPSDT |
| 01 (TX) | 412059301 | TAX ID |
| 05 (TX) | 044422602 | |
| 01 (TX) | 0071JJ | BLUECROSS BLUESHIELD |
| 01 (TX) | 7295208 | AETNA |
Solo or small practice. No other active providers share this practice address in NPPES.
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