NPI age
9 years
Enumerated 2016-06-23
Across 3028 active surgery providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (CO) | TL.0006478 | PHYSICIAN TRAINING LICENSE |
| 01 (MO) | 2016020856 | MISSOURI BOARD OF HEALING ARTS |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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