NPI age
20 years
Enumerated 2005-06-27
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (PA) | 1018018780001 | |
| 01 (TX) | K6640 | STATE LICENSE NUMBER |
| 01 (PA) | OS013698 | MEDICAL LICENSE NUMBER |
| 05 (TX) | 092276701 |
Solo or small practice. No other active providers share this practice address in NPPES.
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