NPI age
19 years
Enumerated 2006-09-01
Across 2087 active general practice providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | P000M1486 | |
| 01 | 03393700 | DMERC |
| 01 | D6073 | STATE BOARD |
Solo or small practice. No other active providers share this practice address in NPPES.
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