NPI age
20 years
Enumerated 2005-07-12
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 139340722 | |
| 01 (TX) | 0073JU | BLUE CROSS AND B.S |
| 01 (TX) | 45D1012386 | LAB EXEMPTION |
| 05 (TX) | 139340720 | |
| 01 (TX) | 611440421 | PRIVATE INSURANCE |
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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