NPI age
15 years
Enumerated 2010-12-02
Across 154 active preventive medicine providers in Texas.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | S6386 | TEXAS MEDICAL LICENSE |
| 01 (LA) | 322610 | LOUISIANA MEDICAL LICENSE |
| 01 (PA) | MT197947 | PA TRAINING LICENSE |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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