Healthcare Provider Details

I. General information

NPI: 1982906806
Provider Name (Legal Business Name): WEST AUSTIN RHEUMATOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12912 HILL COUNTRY BLVD BLDG F STE 238
AUSTIN TX
78738-6328
US

IV. Provider business mailing address

12912 HILL COUNTRY BLVD BLDG F STE 238
AUSTIN TX
78738-6328
US

V. Phone/Fax

Practice location:
  • Phone: 512-732-2929
  • Fax:
Mailing address:
  • Phone: 512-732-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberK0997
License Number StateTX

VIII. Authorized Official

Name: LOREN PECHONIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 512-732-2929