NPI age
20 years
Enumerated 2006-03-24
Across 12343 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 092011803 | |
| 01 (TX) | J8859 | STATE LICENSE |
| 01 (TX) | 00T98D | BCBS |
| 01 (TX) | 742804402 | TAX ID |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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