NPI age
20 years
Enumerated 2005-07-01
Across 1807 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 159613201 | |
| 01 (TX) | K1105 | MEDICAL LICENSE NUMBER |
| 01 (TX) | 0065QV | BCBS GROUP PROV. NO. |
| 01 (TX) | 00569U | MEDICARE GROUP PIN |
| 01 (TX) | 8AJ982 | BCBS PROVIDER NO. |
Part of a multi-provider practice. 8 other active providers share this practice address in NPPES.
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