NPI age
19 years
Enumerated 2006-08-15
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 752947854 | TAX ID |
| 01 (TX) | 10017754 | PROVIDER # FOR AMERIGROUP |
| 05 (TX) | 171442001 | |
| 01 (TX) | 17735 | PROVIDER # FOR PARKLAND |
| 01 (TX) | 8R7200 | PROVIDER # BCBS |
Part of a multi-provider practice. 16 other active providers share this practice address in NPPES.
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