NPI age
19 years
Enumerated 2007-01-24
Across 4038 active specialist providers in Texas.
18 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 4063095 | AETNA |
| 05 (TX) | Z8946 | |
| 01 (TX) | 00JY11 | BLUE CROSS BLUE SHIELD |
| 01 (TX) | G0977 | STATE LICENSE |
Multi-provider organization. 18 individual providers on file at this primary address.
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