| Great Oaks Family Practice, Pa | |
|
15930 S Great Oaks Dr A-200 Round Rock TX 78681-5526 | |
| (512) 246-3338 | |
| (512) 246-3368 |
| Full Name | Great Oaks Family Practice, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 15930 S Great Oaks Dr, Round Rock, Texas |
| Authorized Official Name and Position | David A Diaz (PRESIDENT) |
| Authorized Official Contact | 5122463338 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Oaks Family Practice, Pa 15930 S Great Oaks Dr A-200 Round Rock TX 78681-5526 Ph: (512) 246-3338 | Great Oaks Family Practice, Pa 15930 S Great Oaks Dr A-200 Round Rock TX 78681-5526 Ph: (512) 246-3338 |
| NPI Number | 1417944901 |
|---|---|
| Provider Enumeration Date | 09/30/2005 |
| Last Update Date | 08/08/2014 |
| Medicare PECOS PAC ID | 1658356605 |
|---|---|
| Medicare Enrollment ID | O20040623000194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417944901 | NPI | - | NPPES |
| J1080 | Other | TX | STATE MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | J1080 (Texas) | Primary |
| Provider Name | David A Diaz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033106380 PECOS PAC ID: 7517942568 Enrollment ID: I20040623000284 |
| Provider Name | Pamela Palmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003284688 PECOS PAC ID: 3274843826 Enrollment ID: I20151110002594 |
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