Healthcare Provider Details

I. General information

NPI: 1811172620
Provider Name (Legal Business Name): KERY L. FEFERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 SPICEWOOD SPRINGS RD STE 100
AUSTIN TX
78759-8645
US

IV. Provider business mailing address

4107 SPICEWOOD SPRINGS RD STE 100
AUSTIN TX
78759-8645
US

V. Phone/Fax

Practice location:
  • Phone: 512-139-7336
  • Fax: 512-343-7107
Mailing address:
  • Phone: 512-397-3360
  • Fax: 123-437-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberM7967
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberM7967
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM7967
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: