NPI age
19 years
Enumerated 2007-02-11
Across 749 active internal medicine providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 1W7221 | MEDICARE |
| 01 (KY) | 47166 | KY STATE LICENSE |
| 01 (TX) | 1346381365 | ALL COMERICIAL |
| 05 (TX) | 431614301 |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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