Healthcare Provider Details

I. General information

NPI: 1053504878
Provider Name (Legal Business Name): UNITED OTOLARYNGOLOGY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BEARDSLEY LN SUITE D101
AUSTIN TX
78746-4945
US

IV. Provider business mailing address

300 BEARDSLEY LN SUITE D101
AUSTIN TX
78746-4945
US

V. Phone/Fax

Practice location:
  • Phone: 512-338-9840
  • Fax: 512-338-0863
Mailing address:
  • Phone: 512-338-9840
  • Fax: 512-338-0863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENDAL LANCE STEWART
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 512-338-9840