NPI age
19 years
Enumerated 2006-08-12
Across 130 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 00T52V | BLUE SHIELD |
| 05 (TX) | 111658401 | |
| 01 (TX) | 75-2795302 | TAX ID |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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