NPI age
20 years
Enumerated 2006-03-31
Across 3776 active radiology providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (MN) | 43348 | STATE LICENSE |
| 01 (AZ) | 5608 | STATE LICENSE |
| 05 (TX) | 139107015 | |
| 01 (TN) | 7455 | STATE LICENSE |
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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