NPI age
19 years
Enumerated 2006-08-23
Across 31 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 110734402 | |
| 01 (TX) | 614370 | MEDICARE |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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