MEDICARE: AUSTIN FAMILY ALLERGY & ASTHMA, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00J19X	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1578625190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN FAMILY ALLERGY & ASTHMA, PA

Provider Business Mailing Address
First Line	:	10801-2 NORTH MOPAC EXPWY
Second Line	:	STE 150
City	:	AUSTIN
State	:	TX
Zip	:	78759-5973
Country	:	US
Telephone Number	:	512-346-7936
Fax Number	:	512-388-4450

Provider Business Practice Location Address
First Line	:	10801-2 NORTH MOPAC EXPWY
Second Line	:	STE 150
City	:	AUSTIN
State	:	TX
Zip	:	78759-5973
Country	:	US
Telephone Number	:	512-346-7936
Fax Number	:	512-388-4450

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	ANISA WATROUS
Credential	:
Telephone Number	:	559-436-4500

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	03/23/2026

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