NPI age
19 years
Enumerated 2006-08-11
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 27-0651861 | TAX IDENTIFICATION NUMBER |
| 01 (TX) | E2628 | STATE MEDICAL LICENSE |
| 01 (TX) | H0032565 | TX DPS |
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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