Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2016-06-09
- Last updated
- 2026-03-05
Licenses
- License TX
- U0693
- License KS
- 04-43119
- License TX
- U0693
Location
- Practice location
- 9250 PINECROFT DR
- City
- SHENANDOAH TX
- Postal code
- 773803218
- Phone
- 713-338-5616
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.