Provider Demographics
NPI:1225035363
Name:MERY, AMIN G (MD)
Entity Type:Individual
Prefix:
First Name:AMIN
Middle Name:G
Last Name:MERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAKEWAY CENTRE CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734
Mailing Address - Country:US
Mailing Address - Phone:512-610-3110
Mailing Address - Fax:855-657-6065
Practice Address - Street 1:4 LAKEWAY CENTRE CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734
Practice Address - Country:US
Practice Address - Phone:512-610-3110
Practice Address - Fax:855-657-6065
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0421207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CD502OtherBCBS INDIVIDUAL
TX189537702Medicaid
TX8CD502OtherBCBS INDIVIDUAL
TX8L20245Medicare PIN
TXTXB102751Medicare PIN
TX8D2256Medicare PIN