NPI age
19 years
Enumerated 2006-07-03
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 0017QD | BC/BS |
| 01 (TX) | 00424 | TEXAS CHIP |
| 01 (TX) | 00606G | MEDICARE ID |
| 01 (TX) | 00002 | AETNA EDI PROVIDER ID |
| 05 (TX) | 121246602 | |
| 01 (TX) | 10024877 | AMERIGROUP |
| 05 (TX) | 121246604 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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