Healthcare Provider Details

I. General information

NPI: 1710936307
Provider Name (Legal Business Name): NATACHA PANKRATZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 03/01/2024
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N MAYS ST STE 430
ROUND ROCK TX
78664-2192
US

IV. Provider business mailing address

205 E UNIVERSITY AVE STE 200
GEORGETOWN TX
78626-6821
US

V. Phone/Fax

Practice location:
  • Phone: 512-255-2039
  • Fax: 512-733-7145
Mailing address:
  • Phone: 512-868-1124
  • Fax: 512-868-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM1998
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: