NPI age
19 years
Enumerated 2007-01-22
Across 749 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 1160541-02 | |
| 01 (TX) | 752787826 | TAX IDENTIFICATION NUMBER |
| 01 (TX) | 0002EM | BCBS OF TEXAS, PROV. NO. |
| 01 (TX) | 89490Y | BCBS OF TX PERF PRV |
Part of a multi-provider practice. 57 other active providers share this practice address in NPPES.
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