NPI age
20 years
Enumerated 2006-05-01
Across 130 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 127096903 | |
| 01 (TX) | 10028699 | AMERIGROUP |
| 01 (TX) | 130900703 | MEDICAID EPSDT |
| 01 (TX) | 83214X | BCBS |
| 01 (TX) | 4229409 | AETNA |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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