Healthcare Provider Details

I. General information

NPI: 1861494924
Provider Name (Legal Business Name): ELBERT R. DAVID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 WYOMING SPGS STE 600
ROUND ROCK TX
78681-4305
US

IV. Provider business mailing address

7200 WYOMING SPGS STE 600
ROUND ROCK TX
78681-4305
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-1995
  • Fax: 512-244-2090
Mailing address:
  • Phone: 512-244-1995
  • Fax: 512-244-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG3272
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: