Healthcare Provider Details

I. General information

NPI: 1093785404
Provider Name (Legal Business Name): DAVID BRIAN DELLINGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11623 ANGUS RD SUITE C15
AUSTIN TX
78759-4003
US

IV. Provider business mailing address

11623 ANGUS RD SUITE C15
AUSTIN TX
78759-4003
US

V. Phone/Fax

Practice location:
  • Phone: 512-229-1978
  • Fax: 512-229-1978
Mailing address:
  • Phone: 512-229-1978
  • Fax: 512-402-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH7994
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number34005727
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberH7994
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: