NPI age
20 years
Enumerated 2005-09-21
Across 1318 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | K9004 | TEXAS LICENSE |
| 05 (TX) | 047594902 | |
| 01 (TX) | 290013608 | RR MEDICARE |
| 01 (TX) | 99GH | BLUE CROSS BLUE SHIELD GR |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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