Healthcare Provider Details

I. General information

NPI: 1104825538
Provider Name (Legal Business Name): RONALD LOUIS WOKASIEN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13219 RESEARCH BLVD
AUSTIN TX
78750-3249
US

IV. Provider business mailing address

13219 RESEARCH BLVD
AUSTIN TX
78750-3231
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-0444
  • Fax: 512-335-1986
Mailing address:
  • Phone: 512-250-0444
  • Fax: 512-335-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number674
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: