NPI age
20 years
Enumerated 2005-12-06
Across 2087 active general practice providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 00B91R | BLUE CROSS BLUE SHIELD TX |
| 01 (TX) | G0039 | STATE MEDICAL LICENSE |
| 01 (TX) | 115675 | AETNA |
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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