NPI age
19 years
Enumerated 2006-10-27
Across 3028 active surgery providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (NM) | PENDING | |
| 01 (AL) | 00017674 | STATE LICENSE |
| 05 (WI) | 100095706 |
Part of a multi-provider practice. 12 other active providers share this practice address in NPPES.
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