NPI age
18 years
Enumerated 2008-01-29
Across 6039 active emergency medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 002200 | TEMPORARY LICENSE PERMIT |
| 01 (TX) | 8CA822 | BCBSTX |
| 01 (TX) | N3116 | MEDICAL LICENSE NUMBER |
| 01 (TX) | 1437336773 | TRICARE SOUTH |
Part of a multi-provider practice. 22 other active providers share this practice address in NPPES.
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