Healthcare Provider Details

I. General information

NPI: 1437107612
Provider Name (Legal Business Name): JEREMY GABRYSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W 38TH ST
AUSTIN TX
78705-1006
US

IV. Provider business mailing address

7608 BLACK MOUNTAIN DR
AUSTIN TX
78736-3362
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberL8343
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: