NPI age
20 years
Enumerated 2005-07-12
Across 957 active podiatrist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 171187104 | |
| 01 (TX) | 5304710001 | MEDICARE DME PTAN |
| 01 (TX) | 8B8071 | MEDICARE IND PTAN |
| 01 (TX) | 00528W | MEDICARE GROUP PTAN |
| 01 (TX) | 1548 | TEXAS LICENSE NUMBER |
| 05 (TX) | 152063702 |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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