NPI age
19 years
Enumerated 2006-07-05
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 75709 | |
| 01 (TX) | 752032137 | TAX IDENTIFICATION NUMBER |
| 01 (TX) | GH11 | BC/BS OF TEXAS NUMBER |
| 05 (TX) | 1215071-02 |
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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