NPI age
20 years
Enumerated 2005-08-19
Across 548 active surgery providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 152179101 | |
| 01 (TX) | 742883624 | WORKERS COMP # |
| 01 | 742883624 | FEDERAL TAX ID# |
| 01 (TX) | 8B6021 | BLUE CROSS PROVIDER # |
| 01 (TX) | 0059GS | BLUE CROSS/BLUE SHIELD GROUP |
| 05 (TX) | 031479101 |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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