NPI age
20 years
Enumerated 2005-07-28
Across 167 active dermatology providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 8A2630 | BCBS PROVIDER # |
| 05 (TX) | 1165615-02 | |
| 01 (TX) | J9067 | TX STATE LICENCE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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