NPI age
20 years
Enumerated 2005-12-19
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | G7143 | TL# |
| 05 (TX) | 092665102 | |
| 01 (TX) | 760454735 | TAX ID # |
| 01 (TX) | HX31 | BLUE CROSS BLUE SHIELD |
| 05 (TX) | 092665101 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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