Healthcare Provider Details

I. General information

NPI: 1417574922
Provider Name (Legal Business Name): THOMAS KING HUARD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 BELLAGIO DR
AUSTIN TX
78734-5081
US

IV. Provider business mailing address

112 BELLAGIO DR
AUSTIN TX
78734-5081
US

V. Phone/Fax

Practice location:
  • Phone: 703-408-1750
  • Fax:
Mailing address:
  • Phone: 703-408-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: