NPI age
19 years
Enumerated 2006-09-28
Across 7055 active pediatrics providers in Texas.
3 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 654417 | MEDICARE PART B FOR COMMUNITY ACITON |
| 05 (TX) | 126221402 | |
| 05 (TX) | 126221406 | |
| 01 (TX) | 00166A | BLUE CROSS/BLUE SHIELD |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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