Healthcare Provider Details

I. General information

NPI: 1689863649
Provider Name (Legal Business Name): BRIAN WALTER TEMPLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13917 W. HIGHWAY 71, SUITE A 13917 W. HIGHWAY 71, SUITE A
AUSTIN TX
78738-3008
US

IV. Provider business mailing address

13917 W. HIGHWAY 71, SUITE A 13917 W. HIGHWAY 71, SUITE A
AUSTIN TX
78738-3008
US

V. Phone/Fax

Practice location:
  • Phone: 512-610-7030
  • Fax: 512-610-7034
Mailing address:
  • Phone: 512-610-7030
  • Fax: 512-610-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD27655
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP4118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: