Healthcare Provider Details

I. General information

NPI: 1790764058
Provider Name (Legal Business Name): IAN S ALWARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 WESTERN TRAILS BLVD SUITE 101
AUSTIN TX
78745-1574
US

IV. Provider business mailing address

2555 WESTERN TRAILS BLVD SUITE 101
AUSTIN TX
78745-1574
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 888-663-6331
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberM3856
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM3856
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: