NPI age
15 years
Enumerated 2011-05-17
Across 408 active radiology providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (MD) | D76085 | MARYLAND STATE LICENSE |
| 01 (IN) | 11016009A | INDIANA STATE MEDICAL LICENSING BOARD |
| 01 (TX) | R1919 | TEXAS MEDICAL BOARD |
Part of a multi-provider practice. 26 other active providers share this practice address in NPPES.
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