NPI age
18 years
Enumerated 2008-05-05
Across 15966 active family medicine providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (MN) | 20189 | RESIDENT PERMIT |
| 01 (TX) | 80176832 | DPS |
| 01 (TX) | N7725 | STATE LICENSE |
Part of a multi-provider practice. 34 other active providers share this practice address in NPPES.
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