Healthcare Provider Details

I. General information

NPI: 1013275304
Provider Name (Legal Business Name): WALTER PAUL WERCHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/26/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711-F WEST 38TH STREET BUILDING F1
AUSTIN TX
78701-7201
US

IV. Provider business mailing address

711-F WEST 38TH STREET BUILDING F1
AUSTIN TX
78705-7201
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-6121
  • Fax: 512-452-9171
Mailing address:
  • Phone: 512-458-6121
  • Fax: 512-452-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10042772
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberBP20048261
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberQ8676
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: