Provider Demographics
NPI:1134548399
Name:RIEGER, MARY MICAELA (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MICAELA
Last Name:RIEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MICAELA
Other - Last Name:HOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:911 W 38TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1107
Mailing Address - Country:US
Mailing Address - Phone:512-324-8670
Mailing Address - Fax:
Practice Address - Street 1:911 W 38TH ST STE 202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1107
Practice Address - Country:US
Practice Address - Phone:512-324-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8762207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134548399Medicaid