NPI age
19 years
Enumerated 2006-11-09
Across 3028 active surgery providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 95397 | AMERIGROUP |
| 01 (TX) | J9216 | LICENSE |
| 01 (TX) | 0080DT | BC BS |
| 05 (TX) | 0294068-01 | |
| 01 (TX) | 020044299 | RR MEDICARE |
| 01 (TX) | 5042017 | AETNA |
| 01 (TX) | 752813372 | TAX ID |
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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