NPI age
19 years
Enumerated 2006-11-10
Across 4038 active specialist providers in Texas.
8 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 77074A001 | GROUP TRICARE ID# |
| 05 (TX) | 083465701 | |
| 01 (TX) | CS7997 | RR MEDICARE PIN |
Multi-site organization. 8 additional practice locations on file.
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