NPI age
19 years
Enumerated 2006-09-20
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 4334335 | BLUE LINK NUMBER (BC/BS) |
| 01 (TX) | M0019 | LICENCE |
| 05 (TX) | 175709801 | |
| 01 (TX) | 8R1261 | BC/BS IDENTIFIER |
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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