NPI age
19 years
Enumerated 2006-08-11
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | M0547 | STATE LICENSE |
| 01 (TX) | 74-2579783 | TAX ID # |
| 01 (TX) | 10138495D | TX- DPS |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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