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General NPI Number Information
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NPI Number | 1093052268
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Entity Type | Organization
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Legal Business Name | PRE DIABETES PHYSICIAN SERVICES INC
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 3724 EXECUTIVE CENTER DR STE 150
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City | AUSTIN
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State | TX
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Zip | 78731-1631
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Country | US
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Telephone | 512-623-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 3721 EXECUTIVE CENTER DRIVE STE 160
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City | AUSTIN
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State | TX
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Zip | 78731-1607
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Country | US
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Telephone | 512-623-4900
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Fax | 512-623-4950
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Authorized Official
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Title or Position | CEO
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Name | MR. RANDY MARFIN
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Credential |
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Telephone | 512-623-4928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | TX
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