NPI age
19 years
Enumerated 2007-04-23
Across 4038 active specialist providers in Texas.
20 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 134042408 | |
| 01 (TX) | H9419 | STATE LICENSE |
Multi-provider organization. 20 individual providers on file at this primary address.
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