NPI age
15 years
Enumerated 2011-01-13
Across 1890 active physician assistant providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 10-283 | BOARD CERTIFICATION |
| 01 (TX) | 8418NV | BCBSTX |
| 01 (TX) | SA00553 | LSA LICENSE |
| 01 (TX) | 12678891 | CAQH |
Part of a multi-provider practice. 45 other active providers share this practice address in NPPES.
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