Healthcare Provider Details

I. General information

NPI: 1689660805
Provider Name (Legal Business Name): ANDY C WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4424 GAINES RANCH LOOP STE. 1515
AUSTIN TX
78735-6492
US

IV. Provider business mailing address

PO BOX 41138
AUSTIN TX
78704-0019
US

V. Phone/Fax

Practice location:
  • Phone: 512-796-3893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL9023
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberL9023
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: