Individual
MR. KEVIN JOSEPH GIACONTIERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3500 JEFFERSON ST, STE 200, AUSTIN, TX 78731-6224
(512) 451-0139
(512) 323-5880
Mailing address
3500 JEFFERSON ST, STE 200, AUSTIN, TX 78731-6224
(512) 451-0139
(512) 323-5880
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA01948
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040EE
BLUE CROSS BLUE SHIELD
TX
01
—
88N360
BLUE CROSS BLUE SHIELD
TX
01
—
970030195
MEDICARE RAILROAD
TX
01
—
CK7292
MEDICARE RAILROAD
TX
Enumeration date
06/20/2005
Last updated
05/26/2016
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