NPI age
20 years
Enumerated 2006-02-17
Across 883 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 1710589122 | MEDICAID |
| 05 (OK) | 200017670A | |
| 01 (TX) | 1710589122 | BCBS |
| 05 (TX) | 1710589122 | |
| 05 (TX) | 207309001 |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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