NPI age
19 years
Enumerated 2006-09-16
Across 15966 active family medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 83Y900 | BCBS |
| 01 (TX) | J3744 | LICENSE |
| 01 (TX) | 3250406 | BLUELINK |
| 01 (TX) | 75-2592653 | TAX ID |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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