NPI age
19 years
Enumerated 2006-10-20
Across 729 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 152278101 | |
| 01 | 8G6200 | BCBS TX |
| 01 | 085387101 | MEDICAID TX GROUP NUMBER |
Solo or small practice. No other active providers share this practice address in NPPES.
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