NPI age
20 years
Enumerated 2005-11-16
Across 749 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 130488308 | |
| 01 (TX) | H7707 | STATE MEDICAL LICENSE |
| 01 (TX) | CJ4139 | RAILROAD MEDICARE |
| 01 (TX) | 11352237 | CAQH NUMBER |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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