NPI age
19 years
Enumerated 2006-08-30
Across 15966 active family medicine providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 00N96L | BCBS PROVIDER |
| 01 (TX) | J7063 | STATE LICENSE |
| 01 (TX) | X0125187 | DPS REGISTRATION NUMBER |
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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