Provider Demographics
NPI:1639110034
Name:ECHAVARRY, ERICK Z (PA)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:Z
Last Name:ECHAVARRY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:SKIDMORE
Mailing Address - State:TX
Mailing Address - Zip Code:78389-0467
Mailing Address - Country:US
Mailing Address - Phone:361-364-2804
Mailing Address - Fax:361-364-5014
Practice Address - Street 1:1143 E SINTON ST
Practice Address - Street 2:
Practice Address - City:SINTON
Practice Address - State:TX
Practice Address - Zip Code:78387-2928
Practice Address - Country:US
Practice Address - Phone:361-364-2804
Practice Address - Fax:361-364-5014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C5944Medicare ID - Type Unspecified
TXQ25624Medicare UPIN