NPI age
19 years
Enumerated 2006-10-06
Across 12343 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (OR) | 028357 | |
| 05 (ID) | 807513000 | |
| 01 | 1505102 | PACIFIC SOURCE |
| 01 | 930830668 | GROUP TAX ID |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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