Provider Demographics
NPI:1215002803
Name:DRAGON FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:DRAGON FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-225-6345
Mailing Address - Street 1:2000 SOUTH IH 35
Mailing Address - Street 2:#E1
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681
Mailing Address - Country:US
Mailing Address - Phone:512-225-6345
Mailing Address - Fax:512-692-5205
Practice Address - Street 1:2000 SOUTH IH 35
Practice Address - Street 2:#E1
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681
Practice Address - Country:US
Practice Address - Phone:512-244-1978
Practice Address - Fax:512-244-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
J6637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002EVOtherBCBS
TX141571301Medicaid
0002EVOtherBCBS
TX00187RMedicare PIN