NPI age
20 years
Enumerated 2006-05-31
Across 7055 active pediatrics providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 121542805 | |
| 01 | 412069533 0001 | CIGNA PRV ID NUMBER |
| 05 (TX) | 121542809 | |
| 01 | 42069533001 | TRICARE PROV ID NUMBER |
| 01 (TX) | S0045716 | STATE DPS NUMBER |
| 01 (TX) | 00000034JV | BCBS PROV. NUMBER |
| 01 (VA) | 10018140 | AMERIGROUP PROV ID NUMBER |
| 01 | 3056377 | AETNA PROV NUMBER |
| 01 | 1801833744 | NPI |
| 01 | 236-282-0 | ECFMG NUMBER |
| 01 (MA) | 48268 | MASS BD OF REGISTRATION |
| 01 | 0007929017 | AETNA PIN |
| 05 (TX) | 121542810 | |
| 01 | 31381 | AMERICAN BD OF PEDIATRICS |
| 01 | 45D1007578 | CLIA CERT. OF WAIVER |
| 01 (TX) | G0899 | ST. BD OF MED EXAMINERS |
| 05 (TX) | 121542806 | |
| 05 (TX) | 121542811 | |
| 01 | 236-282-0 | ECFMG |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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