Healthcare Provider Details

I. General information

NPI: 1891843082
Provider Name (Legal Business Name): GEVIN W WILLHELM, DO, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 W PARMER LN STE 1126
AUSTIN TX
78729-4942
US

IV. Provider business mailing address

8701 W PARMER LN STE 1126
AUSTIN TX
78729-4942
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-7661
  • Fax: 512-343-8041
Mailing address:
  • Phone: 512-346-7661
  • Fax: 512-343-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEVIN W WILLHELM
Title or Position: PRESIDENT
Credential: DO
Phone: 512-346-7661