NPI age
17 years
Enumerated 2008-06-04
Across 7055 active pediatrics providers in Texas.
10 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | K3096 | LICENSE NO. |
| 01 (TX) | 0059DF | BLUE CROSS BLUE SHIELD PROV NO. |
| 05 (TX) | 164872701 | |
| 05 (TX) | 164872702 | |
| 01 (TX) | G04053 | UPIN |
Multi-provider organization. 10 individual providers on file at this primary address.
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