NPI age
17 years
Enumerated 2008-07-02
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 1331803-06 | |
| 05 (TX) | 1331803-04 | |
| 01 (TX) | K0154 | STATE MEDICAL LICENSE |
Single-site organization. Only one practice location on file.
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