MEDICARE: PEDRO MANCIAS M.D.

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	2084N0400X	Neurology Physician	J4323	TX
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	J4323	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	130019275	OTHER	TX	RAILROAD MEDICARE

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
2	84519Y	OTHER	TX	BCBSTX
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	84260K	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1316973688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO MANCIAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 301173
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75303-1173
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:	713-500-5711

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST
Second Line	:	1010
City	:	HOUSTON
State	:	TX
Zip	:	77030-3000
Country	:	US
Telephone Number	:	832-325-7151
Fax Number	:	713-500-5711

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

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/05/2016

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Directions to “ PEDRO MANCIAS M.D.” Practice Location

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