Healthcare Provider Details

I. General information

NPI: 1942229059
Provider Name (Legal Business Name): AMY ALCORN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8204 BRODIE LN STE 101
AUSTIN TX
78745-7442
US

IV. Provider business mailing address

PO BOX 26726
AUSTIN TX
78755-0726
US

V. Phone/Fax

Practice location:
  • Phone: 512-282-8967
  • Fax: 512-292-5143
Mailing address:
  • Phone: 512-407-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK9970
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: