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Organization
GEORGETOWN FAMILY & GERIATRIC MEDICINE PLLC
Active
Organization
GEORGETOWN FAMILY & GERIATRIC MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGELIO TREVINO M.D. (OWNER/PRESIDENT)
(512) 869-4800
Entity
Organization
Contact information
Practice address
103 THOUSAND OAKS BLVD, GEORGETOWN, TX 78628-8757
(512) 869-4800
(512) 869-4807
Mailing address
103 THOUSAND OAKS BLVD, GEORGETOWN, TX 78628-8757
(512) 869-4800
(512) 869-4807
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
TX
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010SA
BCBSTX GROUP #
TX
05
—
201407801
—
TX
Enumeration date
01/16/2009
Last updated
01/18/2010
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