NPI age
17 years
Enumerated 2009-04-27
Across 1407 active specialist/technologist, other providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 12678958 | CAQH |
| 01 | 09-288 | ABSA BOARD CERTIFICATION |
| 01 (TX) | 81NN94 | BCBS (SASA) |
| 01 (TX) | SA00485 | LSA LICENSE |
Part of a multi-provider practice. 45 other active providers share this practice address in NPPES.
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