NPI age
19 years
Enumerated 2006-08-07
Across 15966 active family medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (IL) | 036114086 2 | |
| 01 (IL) | 2221474 | BCBS |
| 05 (TX) | 418887201 | |
| 01 (TX) | 8NL795 | BCBS PROVIDER ID |
Part of a multi-provider practice. 12 other active providers share this practice address in NPPES.
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