NPI age
13 years
Enumerated 2012-06-20
Across 7055 active pediatrics providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | Q5573 | MEDICAL LICENSE |
| 05 (TX) | 3481236-03 |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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