NPI age
19 years
Enumerated 2007-03-16
Across 321 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 361904101 | |
| 01 (TX) | 8GB634 | BCBS - TX |
| 05 (TX) | 361904102 | |
| 01 (TX) | MEDICARE | 523595YLLW |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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