Healthcare Provider Details

I. General information

NPI: 1528165255
Provider Name (Legal Business Name): TIN A HLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 METROPOLIS DR
AUSTIN TX
78744-3111
US

IV. Provider business mailing address

1736 CAMP CRAFT RD
WEST LAKE HILLS TX
78746-7317
US

V. Phone/Fax

Practice location:
  • Phone: 512-823-4000
  • Fax:
Mailing address:
  • Phone: 210-490-0519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK6000
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: