NPI age
14 years
Enumerated 2011-11-02
Across 1890 active physician assistant providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 | 126233 | NBSTSA BOARD CERTIFICATION |
| 01 (TX) | SA00515 | LSA LICENSE |
| 01 (TX) | 12678975 | CAQH |
| 01 (TX) | 8EX202 | BCBS |
Part of a multi-provider practice. 45 other active providers share this practice address in NPPES.
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