MEDICARE: AMIN G MERY 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	207K00000X	Allergy & Immunology Physician	L0421	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CD502	OTHER	TX	BCBS INDIVIDUAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225035363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIN G MERY MD

Provider Business Mailing Address
First Line	:	4 LAKEWAY CENTRE CT
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78734
Country	:	US
Telephone Number	:	512-610-3110
Fax Number	:	855-657-6065

Provider Business Practice Location Address
First Line	:	4 LAKEWAY CENTRE CT
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78734
Country	:	US
Telephone Number	:	512-610-3110
Fax Number	:	855-657-6065

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/21/2021

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Directions to “ AMIN G MERY MD” Practice Location

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