NPI age
20 years
Enumerated 2005-06-21
Across 163 active podiatrist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 0346 | STATE LICENSE NUMBER |
| 05 (TX) | 000826001 | |
| 01 (TX) | 00F621 | BLUE CROSS BLUE SHIELD |
| 01 (TX) | 482039423 | MEDICAID DMERC NUMBER |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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