NPI age
20 years
Enumerated 2005-06-28
Across 1136 active podiatrist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 1429 | STATE LICENSE |
| 01 | 8AD030 | BLUE CROSS/BLUE SHIELD |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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