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General NPI Number Information
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NPI Number | 1023287158
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Entity Type | Organization
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Legal Business Name | CONCORD CLINIC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 8000 ANDERSON SQ STE 113
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City | AUSTIN
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State | TX
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Zip | 78757-8482
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Country | US
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Telephone | 512-963-3372
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Fax | 512-233-0721
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Provider Business Mailing Address
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Address Line | 8000 ANDERSON SQ STE 113
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City | AUSTIN
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State | TX
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Zip | 78757-8482
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Country | US
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Telephone | 512-338-0171
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Fax | 512-338-0771
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ROYA AZADI
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Credential | MD
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Telephone | 512-963-3346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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