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General NPI Number Information
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NPI Number | 1013268796
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Entity Type | Organization
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Legal Business Name | VAXWELL LLC
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 631 W 38TH ST SUITE 1
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City | AUSTIN
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State | TX
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Zip | 78705-1250
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Country | US
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Telephone | 512-459-0672
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Fax | 512-420-0974
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Provider Business Mailing Address
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Address Line | 8804 BLUEGRASS DR
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City | AUSTIN
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State | TX
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Zip | 78759-7167
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Country | US
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Telephone | 512-459-0672
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Fax | 512-420-0974
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SIDNEY T ROBIN
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Credential | M.D.
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Telephone | 512-459-0672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | E2824
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License Number State | TX
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