MEDICARE: G R ALBERTSON DO PA

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	207K00000X	Allergy & Immunology Physician	D7899	TX

General Provider Information

NPI Number	:	1063541589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G R ALBERTSON DO PA

Provider Business Mailing Address
First Line	:	4407 BEE CAVE RD
Second Line	:	#113
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6405
Country	:	US
Telephone Number	:	512-338-4336
Fax Number	:	512-343-8197

Provider Business Practice Location Address
First Line	:	4407 BEE CAVE RD
Second Line	:	#113
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6405
Country	:	US
Telephone Number	:	512-338-4336
Fax Number	:	512-343-8197

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. GARY ROGER ALBERTSON
Credential	:	DO
Telephone Number	:	512-338-4336

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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