Healthcare Provider Details

I. General information

NPI: 1689024291
Provider Name (Legal Business Name): JOHN RAYMOND GBUREK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12176 N MOPAC EXPY STE D
AUSTIN TX
78758-2908
US

IV. Provider business mailing address

12176 N MOPAC EXPY STE D
AUSTIN TX
78758-2908
US

V. Phone/Fax

Practice location:
  • Phone: 512-981-7246
  • Fax: 512-981-7246
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberT2167
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: