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Individual
NHI P LE
Active
Individual
NHI P LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K9105
TX
207R00000X
Internal Medicine Physician
K9105
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060466
BLUE LINK
TX
05
—
030189902
—
TX
05
—
030819901
—
TX
01
—
110202064
RAIL ROAD MEDICARE
TX
01
—
7160045
AETNA
TX
01
—
8AD895
BC/BS
TX
01
—
943417821
TAX ID
TX
Enumeration date
08/16/2005
Last updated
06/21/2011
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