Mydas Pa | |
1500 S Main St Ft Worth TX 76104 | |
(817) 702-3431 | |
Not Available |
Full Name | Mydas Pa |
---|---|
Speciality | General Practice |
Location | 1500 S Main St, Ft Worth, Texas |
Authorized Official Name and Position | Nestor Zenarosa (PRESIDENT) |
Authorized Official Contact | 4694205527 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mydas Pa Po Box 650823 Dallas TX 75265-0823 Ph: (469) 420-5527 | Mydas Pa 1500 S Main St Ft Worth TX 76104 Ph: (817) 702-3431 |
NPI Number | 1508296583 |
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Provider Enumeration Date | 11/12/2013 |
Last Update Date | 11/01/2021 |
Medicare PECOS PAC ID | 6406083617 |
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Medicare Enrollment ID | O20131214000233 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508296583 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Neelam Math |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982602512 PECOS PAC ID: 0446153548 Enrollment ID: I20040128000077 |
Provider Name | Josh D Parker |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1710950076 PECOS PAC ID: 8729061437 Enrollment ID: I20040611000992 |
Provider Name | Michael Wayne Mouw |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1063479376 PECOS PAC ID: 9234117268 Enrollment ID: I20040707001495 |
Provider Name | Dora A Guerrero |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285608695 PECOS PAC ID: 5193794253 Enrollment ID: I20040927000643 |
Provider Name | Nestor R Zenarosa |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1629096375 PECOS PAC ID: 9537122874 Enrollment ID: I20041108001253 |
Provider Name | Damalia T Wilson |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1548334659 PECOS PAC ID: 6305832064 Enrollment ID: I20041117000192 |
Provider Name | Steven E Arze |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1659385052 PECOS PAC ID: 3779512587 Enrollment ID: I20050811000264 |
Provider Name | Heidi C Knowles |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1023050440 PECOS PAC ID: 2365445137 Enrollment ID: I20060816000422 |
Provider Name | David P Bryant |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1548233968 PECOS PAC ID: 4688656432 Enrollment ID: I20061026000480 |
Provider Name | Amy C Young |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1326095720 PECOS PAC ID: 3577564293 Enrollment ID: I20070124000174 |
Provider Name | Nikki B Berry |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699842195 PECOS PAC ID: 5597867986 Enrollment ID: I20070627000281 |
Provider Name | Dahlia M Hassani |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1649297656 PECOS PAC ID: 7113965310 Enrollment ID: I20071129000607 |
Provider Name | James P Detienne |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1003834714 PECOS PAC ID: 2264502756 Enrollment ID: I20080610000789 |
Provider Name | John Pease |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1609840982 PECOS PAC ID: 6204990682 Enrollment ID: I20090616000470 |
Provider Name | Charles A Huggins |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1669634838 PECOS PAC ID: 3678649530 Enrollment ID: I20090827000553 |
Provider Name | Galina Ronin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1235463449 PECOS PAC ID: 8123165016 Enrollment ID: I20091026000533 |
Provider Name | Jimmy Aleman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679809024 PECOS PAC ID: 9335284280 Enrollment ID: I20100303000999 |
Provider Name | Gregory P Gleim |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1083728224 PECOS PAC ID: 7315074119 Enrollment ID: I20100428000134 |
Provider Name | Hao Wang |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1235320375 PECOS PAC ID: 4385737055 Enrollment ID: I20100513000820 |
Provider Name | Chet D Schrader |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1043235344 PECOS PAC ID: 4183783368 Enrollment ID: I20100719000370 |
Provider Name | John Garrett |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1417086364 PECOS PAC ID: 7113078114 Enrollment ID: I20100727001047 |
Provider Name | Katherine Parrish |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1154624476 PECOS PAC ID: 9537345863 Enrollment ID: I20110520000153 |
Provider Name | Stefan Buca |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1417121799 PECOS PAC ID: 1850578816 Enrollment ID: I20110601000074 |
Provider Name | Brad J Silver |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1922274497 PECOS PAC ID: 1153508635 Enrollment ID: I20110609000542 |
Provider Name | Peter M Gruman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326342965 PECOS PAC ID: 3678751518 Enrollment ID: I20110624000245 |
Provider Name | Laine F Foran |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1265477996 PECOS PAC ID: 4284802265 Enrollment ID: I20110718000531 |
Provider Name | Andrew D Shedd |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1972769065 PECOS PAC ID: 5092984500 Enrollment ID: I20110817000442 |
Provider Name | Zeboonisha Damji |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497034607 PECOS PAC ID: 9830361674 Enrollment ID: I20111020000310 |
Provider Name | Carina C Manalo |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1487942280 PECOS PAC ID: 1557536588 Enrollment ID: I20111202000357 |
Provider Name | Oluwayemisi O Agboola |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114210648 PECOS PAC ID: 2365602224 Enrollment ID: I20120329000866 |
Provider Name | Krystle F Garrett Green |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457669210 PECOS PAC ID: 5496901977 Enrollment ID: I20120816000346 |
Provider Name | Michele Denise Lightfoot |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659633311 PECOS PAC ID: 7416104724 Enrollment ID: I20120821000911 |
Provider Name | Joseph M Young |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1629395363 PECOS PAC ID: 7719136324 Enrollment ID: I20120925000482 |
Provider Name | Rhoda G Stevens |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033467477 PECOS PAC ID: 3072763556 Enrollment ID: I20121017000954 |
Provider Name | Jessica L Ives |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902153505 PECOS PAC ID: 3577713700 Enrollment ID: I20121025000136 |
Provider Name | Brandi Cole |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902148109 PECOS PAC ID: 5799924874 Enrollment ID: I20130621000070 |
Provider Name | Holly K Yamauchi |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972854388 PECOS PAC ID: 8325288137 Enrollment ID: I20130627000760 |
Provider Name | Cheryl A Gordon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801230727 PECOS PAC ID: 6406096437 Enrollment ID: I20130715000695 |
Provider Name | Ryan Andrew Stroder |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1154647113 PECOS PAC ID: 4880836329 Enrollment ID: I20130812000722 |
Provider Name | Lindsie D Smitherman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477895241 PECOS PAC ID: 4284877275 Enrollment ID: I20130823000126 |
Provider Name | Corina C Sturgeon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457693228 PECOS PAC ID: 4587807441 Enrollment ID: I20130826000672 |
Provider Name | Amber Lanea Colbert |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982037586 PECOS PAC ID: 0143457655 Enrollment ID: I20131207000308 |
Provider Name | Mee Ok Kim |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912176595 PECOS PAC ID: 9032346333 Enrollment ID: I20131212000257 |
Provider Name | Robert L Lewis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407285513 PECOS PAC ID: 0840421061 Enrollment ID: I20140401000175 |
Provider Name | Elsa Abraham Thuruthel |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013332782 PECOS PAC ID: 1951534858 Enrollment ID: I20140430000640 |
Provider Name | Ferran Ros |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1275832727 PECOS PAC ID: 5799908273 Enrollment ID: I20140602001997 |
Provider Name | Jo A Leuck |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1922138460 PECOS PAC ID: 0749356251 Enrollment ID: I20140609001259 |
Provider Name | Lessie C Harlin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033536115 PECOS PAC ID: 6507081106 Enrollment ID: I20140715000394 |
Provider Name | Bharti R Chaudhari |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1043538481 PECOS PAC ID: 5698913432 Enrollment ID: I20140807000628 |
Provider Name | Tommora D Jackson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497075097 PECOS PAC ID: 6204053556 Enrollment ID: I20140808001922 |
Provider Name | Veer Vithalani |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1750670451 PECOS PAC ID: 9537387618 Enrollment ID: I20140903000629 |
Provider Name | Adam R Jennings |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1821397068 PECOS PAC ID: 0345469011 Enrollment ID: I20140910002015 |
Provider Name | Katherine Holmes |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1841518024 PECOS PAC ID: 5890939615 Enrollment ID: I20140925001787 |
Provider Name | Christine Annette Tracy |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1740568708 PECOS PAC ID: 2668692930 Enrollment ID: I20141008002121 |
Provider Name | Chad T Holmes |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1306164520 PECOS PAC ID: 4688818412 Enrollment ID: I20141021000827 |
Provider Name | Jamecia L Finnie |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1801188180 PECOS PAC ID: 0941421259 Enrollment ID: I20141029001276 |
Provider Name | Michael Joseph Barra |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1477672483 PECOS PAC ID: 7911059787 Enrollment ID: I20141206000156 |
Provider Name | Anant K Patel |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1447516968 PECOS PAC ID: 0042532558 Enrollment ID: I20141210002441 |
Provider Name | Sarah Elizabeth Rochfort |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407866932 PECOS PAC ID: 1052316080 Enrollment ID: I20150105000271 |
Provider Name | D'laine Gutmann |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306244918 PECOS PAC ID: 1557685708 Enrollment ID: I20150120000135 |
Provider Name | Sandra M Schneider |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1508885922 PECOS PAC ID: 2668559642 Enrollment ID: I20150921002083 |
Provider Name | Kristina Halina Domanski |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1417213869 PECOS PAC ID: 3274841739 Enrollment ID: I20151001002847 |
Provider Name | Rachel Harrington |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1710329859 PECOS PAC ID: 3779701313 Enrollment ID: I20151020002369 |
Provider Name | Hayleyesus P Gulilat |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1316310170 PECOS PAC ID: 7113227802 Enrollment ID: I20151202001361 |
Provider Name | Lavonia C Aduba |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679947618 PECOS PAC ID: 3274822374 Enrollment ID: I20160512001416 |
Provider Name | Sara S Toler |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699031815 PECOS PAC ID: 2567767957 Enrollment ID: I20160701000426 |
Provider Name | Nichole M Alegria |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255788378 PECOS PAC ID: 5698068443 Enrollment ID: I20160801002051 |
Provider Name | Natasha Singh |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1316384837 PECOS PAC ID: 9830484047 Enrollment ID: I20160827000046 |
Provider Name | Ian Apollos Justl Ellis |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1073856183 PECOS PAC ID: 3779879820 Enrollment ID: I20160915002157 |
Provider Name | Sonija Shrestha |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1154779064 PECOS PAC ID: 4284922113 Enrollment ID: I20161010001551 |
Provider Name | Lashindra J Norris |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457803124 PECOS PAC ID: 2769762848 Enrollment ID: I20161207000451 |
Provider Name | Jane E Classen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760926695 PECOS PAC ID: 8628359650 Enrollment ID: I20170104002205 |
Provider Name | Jesse Baker |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417405291 PECOS PAC ID: 7517248438 Enrollment ID: I20170106001095 |
Provider Name | Autumn R Hall |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306396809 PECOS PAC ID: 8527349323 Enrollment ID: I20170110003214 |
Provider Name | Theresa Franco Roy |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1215481544 PECOS PAC ID: 8820370489 Enrollment ID: I20170117001393 |
Provider Name | Todd M Phillips |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1205122660 PECOS PAC ID: 4385872902 Enrollment ID: I20170121000024 |
Provider Name | Ryan P Kirby |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1053573055 PECOS PAC ID: 9638335615 Enrollment ID: I20170123002463 |
Provider Name | Jessica Jewart Kirby |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1598964900 PECOS PAC ID: 2961569652 Enrollment ID: I20170123002743 |
Provider Name | Bear B Causseaux |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770034548 PECOS PAC ID: 5799068052 Enrollment ID: I20170210001177 |
Provider Name | Elisabeth Ann Danforth Martinez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1851846356 PECOS PAC ID: 2961787569 Enrollment ID: I20170322001688 |
Provider Name | Amy Faith Ho |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1356755854 PECOS PAC ID: 1355644188 Enrollment ID: I20170505001557 |
Provider Name | Mathew Roy |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801243779 PECOS PAC ID: 4880962794 Enrollment ID: I20170619001296 |
Provider Name | Sara E Donley |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245780154 PECOS PAC ID: 6800167651 Enrollment ID: I20170812000036 |
Provider Name | Billy E Catlett |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538449780 PECOS PAC ID: 4880951839 Enrollment ID: I20171129000272 |
Provider Name | Teresa A Proietti |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1235525312 PECOS PAC ID: 8729347489 Enrollment ID: I20180125002774 |
Provider Name | Marcus B Holmes |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1114312667 PECOS PAC ID: 9830459213 Enrollment ID: I20180202001036 |
Provider Name | Nicole A Remish |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1942695796 PECOS PAC ID: 2163783788 Enrollment ID: I20180222001989 |
Provider Name | Briana D Mazur |
---|---|
Provider Type | Practitioner - Hospice/palliative Care |
Provider Identifiers | NPI Number: 1457739658 PECOS PAC ID: 3072801208 Enrollment ID: I20180305002412 |
Provider Name | Monica Renee Bravo |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639673494 PECOS PAC ID: 1951664267 Enrollment ID: I20180420000086 |
Provider Name | Katherine Franklin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689170185 PECOS PAC ID: 4385908102 Enrollment ID: I20180503000056 |
Provider Name | Ryne B Johnson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245734011 PECOS PAC ID: 0547515090 Enrollment ID: I20180625001048 |
Provider Name | Hunter P Langley |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073016754 PECOS PAC ID: 9032465083 Enrollment ID: I20180703003152 |
Provider Name | Jenelle Dugan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841777000 PECOS PAC ID: 8022369990 Enrollment ID: I20180918000079 |
Provider Name | Sheeba Thomas |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013443696 PECOS PAC ID: 2961755269 Enrollment ID: I20181105000194 |
Provider Name | Austi J Roberts |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144703463 PECOS PAC ID: 1850645649 Enrollment ID: I20181114001436 |
Provider Name | Jon A Wolfshohl |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1861856999 PECOS PAC ID: 4486997137 Enrollment ID: I20190520002870 |
Provider Name | Cornelius O Powell |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1780048348 PECOS PAC ID: 3678806270 Enrollment ID: I20190613002603 |
Provider Name | Julie Anne Rogers |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417469966 PECOS PAC ID: 0941530448 Enrollment ID: I20190926000517 |
Provider Name | Amy Rose Gregor |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972146421 PECOS PAC ID: 9537595285 Enrollment ID: I20200129000560 |
Provider Name | Jennifer Danielle Byrd |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1023540135 PECOS PAC ID: 2668893900 Enrollment ID: I20200522000619 |
Provider Name | Michael Hochberg |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1932279114 PECOS PAC ID: 8729069265 Enrollment ID: I20200623001474 |
Provider Name | Twila May Shuquist |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306450697 PECOS PAC ID: 3173912979 Enrollment ID: I20211117001203 |
Provider Name | Robert Sullivan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972131027 PECOS PAC ID: 9931599545 Enrollment ID: I20211214000072 |
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