NPI age
19 years
Enumerated 2006-10-05
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 45D1034142 | CLIA |
| 01 (TX) | J4527 | MEDICAL LICENSE |
| 01 (TX) | 00850X | GROUP MEDICARE |
| 01 (TX) | 0026MA | GROUP BC/BS |
| 05 (TX) | 118586004 | |
| 01 (TX) | 169940701 | GROUP MEDICAID |
| 01 (TX) | 8R1210 | BLUE CROSS BLUE SHIELD |
Part of a multi-provider practice. 28 other active providers share this practice address in NPPES.
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