NPI age
19 years
Enumerated 2007-04-12
Across 15966 active family medicine providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 | P00760408 | RAIL ROAD MEDICARE |
| 05 (IN) | 200944160 | |
| 01 (IN) | 100180890G | MEDICAID GROUP |
| 01 (KY) | 50027287 | PASSPORT |
| 01 | 000000618860 | ANTHEM PIN |
| 05 (KY) | 7100090290 |
Part of a multi-provider practice. 68 other active providers share this practice address in NPPES.
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