Healthcare Provider Details

I. General information

NPI: 1033416870
Provider Name (Legal Business Name): BRYAN L TOWNSEND MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8044 SHOAL CREEK BLVD
AUSTIN TX
78757-8039
US

IV. Provider business mailing address

8044 SHOAL CREEK BLVD
AUSTIN TX
78757-8039
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-1269
  • Fax: 512-459-1404
Mailing address:
  • Phone: 512-459-1269
  • Fax: 512-459-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberJ4566
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberJ4566
License Number StateTX

VIII. Authorized Official

Name: BRYAN L TOWNSEND
Title or Position: OWNER
Credential: MD
Phone: 512-459-1269