Provider Demographics
NPI:1467427419
Name:TEXAS DIABETES AND ENDOCRINOLOGY, P.A.
Entity Type:Organization
Organization Name:TEXAS DIABETES AND ENDOCRINOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-458-8400
Mailing Address - Street 1:6500 NORTH MO PAC EXPRESSWAY
Mailing Address - Street 2:BUILDING 3, SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-458-8400
Mailing Address - Fax:512-458-8593
Practice Address - Street 1:6500 NORTH MO PAC EXPRESSWAY
Practice Address - Street 2:BUILDING 3, SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-458-8400
Practice Address - Fax:512-458-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RE0101X, 364S00000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX710ROtherBCBS GROUP #
TX710ROtherBCBS GROUP #