NPI age
19 years
Enumerated 2006-12-07
Across 143 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | G6939 | LICENSE |
| 05 (TX) | 136304611 | |
| 01 (TX) | 136304612 | MEDICAID-CSHCN |
| 01 (TX) | H08FR80701 | BCBS |
Part of a multi-provider practice. 14 other active providers share this practice address in NPPES.
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