NPI age
18 years
Enumerated 2007-12-27
Across 2087 active general practice providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (CA) | G41184 | MEDICAL LICENSE |
| 01 (PA) | GR164327 | MEDICARE PROVIDER # |
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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