Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | J4323 | TX |
Y | 2084N0402X | Child Neurologist | J4323 | TX |
NPI | 1316973688 |
---|---|
Provider Name | Pedro Mancias |
First Address | Dallas, TX 75303-1173 |
Second Address | Houston, TX 77030-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 05/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130019275 | RAILROAD MEDICARE (01) | TX |
135980402 | (05) | TX |
182058101 | (05) | TX |
84260K | BCBS (01) | TX |
84519Y | BCBSTX (01) | TX |
F73742 | (02) | TX |