NPI age
19 years
Enumerated 2006-10-04
Across 1466 active clinic/center providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 571157825 | TAX IDENTIFICATION |
| 01 (TX) | L5484 | STATE LICENSE |
| 05 (TX) | 158648904 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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