Provider Demographics
NPI:1558378893
Name:PRICE, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:PRICE
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 1:201 FM 3237 STE 111
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-2119
Mailing Address - Country:US
Mailing Address - Phone:512-847-3434
Mailing Address - Fax:512-847-6795
Practice Address - Street 1:201 FM 3237 STE 111
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-2119
Practice Address - Country:US
Practice Address - Phone:512-847-3434
Practice Address - Fax:512-847-6795
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304680701Medicaid
P01082812OtherRR MEDICARE
TXB143901OtherMEDICARE
OR288372Medicaid
OR048194013OtherBLUE CROSS BLUE SHIELD