Healthcare Provider Details

I. General information

NPI: 1962473769
Provider Name (Legal Business Name): KOREN WESTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KOREN DINGEMAN M.D.

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR STE 204
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

11149 RESEARCH BLVD SUITE 210
AUSTIN TX
78759-5279
US

V. Phone/Fax

Practice location:
  • Phone: 855-481-8375
  • Fax:
Mailing address:
  • Phone: 512-231-1901
  • Fax: 512-231-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL4802
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberL4802
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL4802
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: