NPI age
19 years
Enumerated 2006-07-11
Across 15966 active family medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | B0104946 | DPS |
| 01 (TX) | 0-417-859-6 | ECFMG |
| 01 (TX) | K2521 | MEDICAL LICENSE |
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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