Healthcare Provider Details

I. General information

NPI: 1235144304
Provider Name (Legal Business Name): ROSS F PROCHNOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 SETON CENTER PKWY #220
AUSTIN TX
78759-5784
US

IV. Provider business mailing address

PO BOX 26726
AUSTIN TX
78755-0726
US

V. Phone/Fax

Practice location:
  • Phone: 512-338-8388
  • Fax: 512-338-8465
Mailing address:
  • Phone: 512-407-8686
  • Fax: 512-421-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG6989
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG6989
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: