Healthcare Provider Details

I. General information

NPI: 1346242989
Provider Name (Legal Business Name): ISABEL VREELAND HOVERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 GLENVIEW AVE
AUSTIN TX
78703-1448
US

IV. Provider business mailing address

3407 GLENVIEW AVE
AUSTIN TX
78703-1448
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-3149
  • Fax: 512-459-6974
Mailing address:
  • Phone: 512-459-3149
  • Fax: 512-459-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF0522
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: