NPI age
19 years
Enumerated 2006-06-07
Across 15966 active family medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 | 45D1072789 | CLIA |
| 01 (TX) | P00463690 | MEDICARE RR PTAN |
| 01 (TX) | DG9427 | MEDICARE RR GROUP |
| 05 (TX) | 133752906 |
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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