Robert    Parker    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005241
NPI
1740381771
Tax ID
741970370
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
12121 Richmond Avenue Suite 217
Houston, TX 77082
United States
County
Harris
Phone
2815588872 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address