NPI age
20 years
Enumerated 2005-10-19
Across 159 active surgery providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | G0165380 | TEXAS DEPARTMENT OF PUBLIC SAFETY |
| 01 (GA) | 056062 | MEDICAL LICENSE |
| 01 (VA) | 0101055420 | MEDICAL LICENSE |
| 01 | TEMP 10APR2009 | TEXAS MEDICAL BOARD |
| 01 (NE) | 18256 | MEDICAL LICENSE |
| 01 | N3048 | TX MED BOARD LICENSE |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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