NPI age
19 years
Enumerated 2007-03-14
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (IN) | 300037734 | |
| 01 (IN) | 191360049 | MEDICARE PTAN |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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