Healthcare Provider Details

I. General information

NPI: 1477643880
Provider Name (Legal Business Name): NORTH STAR FAMILY MEDICINE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 WYOMING SPGS BLDG 3 SUITE 700
ROUND ROCK TX
78681-4312
US

IV. Provider business mailing address

7215 WYOMING SPGS BUILDING 3 SUITE 700
ROUND ROCK TX
78681-4312
US

V. Phone/Fax

Practice location:
  • Phone: 512-225-6345
  • Fax: 512-225-6344
Mailing address:
  • Phone: 512-225-6345
  • Fax: 512-225-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK4308
License Number State

VIII. Authorized Official

Name: SANDRA A ARNOLD
Title or Position: ADMIN ASST
Credential:
Phone: 512-225-6345