Healthcare Provider Details

I. General information

NPI: 1023271301
Provider Name (Legal Business Name): PARVIZ K KAVOUSSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 JAMES CASEY ST SUITE B
AUSTIN TX
78745-1188
US

IV. Provider business mailing address

4303 JAMES CASEY ST SUITE B
AUSTIN TX
78745-1188
US

V. Phone/Fax

Practice location:
  • Phone: 512-444-1414
  • Fax: 512-326-5319
Mailing address:
  • Phone: 512-444-1414
  • Fax: 512-326-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberM8756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: