NPI age
20 years
Enumerated 2006-05-08
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | L4488 | MEDICAL LICENSE |
| 01 (TX) | 05-0622563 | TAX NUMBER |
| 01 (TX) | 7313193 | AETNA PIN NUMBER |
| 01 (TX) | 0020KW | BCBS PROVIDER ID |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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