Healthcare Provider Details

I. General information

NPI: 1427389089
Provider Name (Legal Business Name): VIRTUAL.MD SOFTWARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 JAMES CASEY ST # F-200
AUSTIN TX
78745-1116
US

IV. Provider business mailing address

3029 COVINGTON PL
ROUND ROCK TX
78681-2287
US

V. Phone/Fax

Practice location:
  • Phone: 512-632-4886
  • Fax: 512-236-5196
Mailing address:
  • Phone: 512-632-4886
  • Fax: 512-236-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberJ2712
License Number StateTX

VIII. Authorized Official

Name: ALEXANDER O'BRIEN
Title or Position: OWNER
Credential:
Phone: 512-632-4886