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NPI Code Detail

MEDICARE: DR. ANNE WEATHERLY MAHAN MD

MEDICARE: DR. ANNE WEATHERLY MAHAN 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
12080P0203XPediatric Critical Care Medicine PhysicianN8684TX
2208000000XPediatrics PhysicianN8684TX

General Provider Information

NPI Number : 1790989366
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANNE WEATHERLY MAHAN MD
Provider Business Mailing Address
First Line : 5339 N IH 35 STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78723-2558
Country : US
Telephone Number : 512-628-1898
Fax Number :
Provider Business Practice Location Address
First Line : 5339 N IH 35 STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78723-2558
Country : US
Telephone Number : 512-628-1898
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2007
Last Update Date : 11/13/2018

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