Provider Demographics
NPI:1578595690
Name:SARGENT, MARY CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:SARGENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:M
Other - Middle Name:CATHERINE
Other - Last Name:SARGENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3077
Mailing Address - Country:US
Mailing Address - Phone:512-478-8116
Mailing Address - Fax:512-478-9368
Practice Address - Street 1:1301 BARBARA JORDAN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3077
Practice Address - Country:US
Practice Address - Phone:512-478-8116
Practice Address - Fax:512-478-9368
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4066207X00000X, 207XP3100X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2080327-05Medicaid
TX208032701Medicaid
TX8CD812OtherBCBS INDIVIDUAL #
TX208032702OtherMEDICAID CSHCN
TX2080327-06OtherMEDICAID CSHCN ROT
TX2080327-05Medicaid
TXTXB130873Medicare PIN