NPI age
19 years
Enumerated 2007-04-19
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (OK) | 2000788830A | |
| 01 (TX) | 0062MB | BLUE CROSS BLUE SHIELD |
| 01 (TX) | XD127252 | DPS NUMBER |
| 01 (TX) | L5755 | LICENSE NUMBER |
| 05 (TX) | 156051802 |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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