MEDICARE: JAY L VIERNES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	M3415	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000302315	OTHER	HI	HMSA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053399477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY L VIERNES MD

Provider Business Mailing Address
First Line	:	6210 E HIGHWAY 290
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-1142
Country	:	US
Telephone Number	:	512-483-9596
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	6811 AUSTIN CENTER BLVD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-3146
Country	:	US
Telephone Number	:	512-346-8888
Fax Number	:	512-344-0365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	05/03/2021

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Directions to “ JAY L VIERNES MD” Practice Location

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