Healthcare Provider Details

I. General information

NPI: 1376575886
Provider Name (Legal Business Name): AUSTIN GERIATRIC SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12731 RESEARCH BLVD STE B200
AUSTIN TX
78759
US

IV. Provider business mailing address

1108 LAVACA ST STE 110-320
AUSTIN TX
78701-2172
US

V. Phone/Fax

Practice location:
  • Phone: 877-856-3774
  • Fax: 512-482-0390
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LIAM M FRY
Title or Position: OWNER
Credential: MD
Phone: 877-856-3774