Healthcare Provider Details

I. General information

NPI: 1508872888
Provider Name (Legal Business Name): DEBORAH K. COUNTIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH K. BRYANT MD

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 SETON CENTER PKWY #220
AUSTIN TX
78759-5784
US

IV. Provider business mailing address

4515 SETON CENTER PKWY SUITE 215
AUSTIN TX
78759-5290
US

V. Phone/Fax

Practice location:
  • Phone: 512-338-8388
  • Fax: 512-406-6274
Mailing address:
  • Phone: 512-231-5507
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ3056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: