Healthcare Provider Details

I. General information

NPI: 1710301874
Provider Name (Legal Business Name): FLORA MEDICAL CLINIC-PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 STECK AVE STE A110
AUSTIN TX
78759-8647
US

IV. Provider business mailing address

3921 STECK AVE STE A110
AUSTIN TX
78759-8647
US

V. Phone/Fax

Practice location:
  • Phone: 512-476-9934
  • Fax: 512-476-8404
Mailing address:
  • Phone: 512-476-9934
  • Fax: 512-476-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberL0347
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AUDREY GLASER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 512-476-9934