Healthcare Provider Details

I. General information

NPI: 1871683540
Provider Name (Legal Business Name): VIKRAM DURAIRAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 MEDICAL PKWY SUITE 120
AUSTIN TX
78705-1019
US

IV. Provider business mailing address

3705 MEDICAL PKWY SUITE 120
AUSTIN TX
78705-1019
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-2141
  • Fax: 512-458-4824
Mailing address:
  • Phone: 512-458-2141
  • Fax: 512-458-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberP8128
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberP8128
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: