NPI age
19 years
Enumerated 2006-08-04
Across 3028 active surgery providers in Texas.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 179313501 | |
| 01 (TX) | 0085NR | BCBS GROUP |
| 01 (TX) | L8172 | STATE LICENSE |
| 01 (TX) | 051736 | ECFMG NUMBER |
| 01 | 1356303960 | NPI INDIVIDUAL NUMBER |
| 01 (TX) | 8V9840 | BCBS INVIDUAL |
| 05 (TX) | 179314301 |
Multi-provider organization. 1 individual provider on file at this primary address.
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