NPI age
15 years
Enumerated 2010-10-18
Across 4038 active specialist providers in Texas.
2 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | CS2639 | RR MEDICARE |
| 01 | 0068WA | BCBS |
| 01 (TX) | 282271001 | GROUP MEDICAID NO. |
| 05 (TX) | 1155491-03 |
Multi-provider organization. 2 individual providers on file at this primary address.
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