MEDICARE: ERICK Z ECHAVARRY P.A.

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	363A00000X	Physician Assistant	PA00404	TX

General Provider Information

NPI Number	:	1639110034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICK Z ECHAVARRY P.A.

Provider Business Mailing Address
First Line	:	PO BOX 467
Second Line	:
City	:	SKIDMORE
State	:	TX
Zip	:	78389-0467
Country	:	US
Telephone Number	:	361-364-2804
Fax Number	:	361-364-5014

Provider Business Practice Location Address
First Line	:	1143 E SINTON ST
Second Line	:
City	:	SINTON
State	:	TX
Zip	:	78387-2928
Country	:	US
Telephone Number	:	361-364-2804
Fax Number	:	361-364-5014

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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