NPI age
18 years
Enumerated 2008-02-11
Across 4038 active specialist providers in Texas.
14 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | J1937 | STATE LICENSE NUMBER |
| 01 (TX) | 0064LP | BCBS INDIVIDUAL |
Multi-provider organization. 14 individual providers on file at this primary address.
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