MEDICARE: DR. TAMMY S MCCONNELL D.O.

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	208000000X	Pediatrics Physician	L9249	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8S5306	OTHER	TX	BCBS PIN

General Provider Information

NPI Number	:	1801896246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMY S MCCONNELL D.O.

Provider Business Mailing Address
First Line	:	1912 W. 35TH ST.
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703
Country	:	US
Telephone Number	:	512-451-5161
Fax Number	:	512-451-1258

Provider Business Practice Location Address
First Line	:	1912 W. 35TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703
Country	:	US
Telephone Number	:	512-451-5161
Fax Number	:	512-451-1258

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/18/2015

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