NPI age
19 years
Enumerated 2007-04-02
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 00Y500 | MEDICARE GROUP |
| 01 (TX) | 0074QG | BCBS |
| 05 (TX) | 12249902 | |
| 01 (TX) | J3092 | STATE LICENCE NUMBER |
Single-site organization. Only one practice location on file.
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