MEDICARE: ERNESTO LIRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	K9599	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063494003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO LIRA MD

Provider Business Mailing Address
First Line	:	4833 SARATOGA PMB 606
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413
Country	:	US
Telephone Number	:	361-851-0000
Fax Number	:	361-653-2538

Provider Business Practice Location Address
First Line	:	4613 S STAPLES ST STE C&D
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-2605
Country	:	US
Telephone Number	:	361-851-0000
Fax Number	:	361-653-2543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	05/19/2011

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Directions to “ ERNESTO LIRA MD” Practice Location

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