NPI age
9 years
Enumerated 2016-09-16
Across 2087 active general practice providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (VA) | 0101265916 | VIRGINIA MEDICAL LICENSE |
| 01 (TX) | T3896 | TEXAS MEDICAL LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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