NPI age
19 years
Enumerated 2007-01-09
Across 12343 active internal medicine providers in Texas.
3 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 00358Y | MEDICARE GROUP PTAN |
| 01 (TX) | K0026 | STATE LICENSE |
| 01 (TX) | 8937M0 | BCBS PROV NO. |
| 05 (TX) | 172115101 |
Multi-site organization. 3 additional practice locations on file.
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