NPI age
20 years
Enumerated 2006-05-06
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 1093083560 | GRP NPI |
| 01 (TX) | 0999351 | AMERIGROUP |
| 01 (TX) | 265403YN0Q | MCPTAN |
| 01 (TX) | 36-412381 | TIN # |
| 01 (TX) | J2983 | TEXAS LICENSE |
| 05 (TX) | 099935106 | |
| 01 (TX) | P01153365 | RR MEDICARE |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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