| Cornelia L Agent Md Pa | |
|
215 W Blackstone Ln Alvin TX 77511-3407 | |
| (281) 331-5253 | |
| (281) 585-4074 |
| Full Name | Cornelia L Agent Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 215 W Blackstone Ln, Alvin, Texas |
| Authorized Official Name and Position | Cornelia L Agent (OWNER) |
| Authorized Official Contact | 2813315253 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornelia L Agent Md Pa 215 W Blackstone Ln Alvin TX 77511-3407 Ph: (281) 331-5253 | Cornelia L Agent Md Pa 215 W Blackstone Ln Alvin TX 77511-3407 Ph: (281) 331-5253 |
| NPI Number | 1831473354 |
|---|---|
| Provider Enumeration Date | 10/03/2011 |
| Last Update Date | 10/03/2011 |
| Medicare PECOS PAC ID | 8820251887 |
|---|---|
| Medicare Enrollment ID | O20120531000584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831473354 | NPI | - | NPPES |
| 114075801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | F9123 (Texas) | Primary |
| Provider Name | Cornelia L Agent |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457452526 PECOS PAC ID: 4789848714 Enrollment ID: I20120604000226 |
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