Provider Demographics
NPI:1316973688
Name:MANCIAS, PEDRO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:MANCIAS
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:PO BOX 301173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1173
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:713-500-5711
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:1010
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:832-325-7151
Practice Address - Fax:713-500-5711
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ43232084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135980402Medicaid
TX84519YOtherBCBSTX
TX130019275OtherRAILROAD MEDICARE
TX182058101Medicaid
TX84260KOtherBCBS
TX84260KMedicare PIN
TX182058101Medicaid
TX8G7907Medicare PIN