NPI age
19 years
Enumerated 2007-01-09
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | M2487 | TEXAS LICENSE |
| 05 (TX) | 178296302 | |
| 05 (TX) | 178296301 | |
| 05 (TX) | 178297101 |
Single-site organization. Only one practice location on file.
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