Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2006-08-11
- Last updated
- 2015-12-31
Specialties
Licenses
- License TX
- K3255
Location
- Practice location
- 911 23RD ST
- City
- CANYON TX
- Postal code
- 790154600
- Phone
- 806-655-2104
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.