=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215002803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRAGON FAMILY MEDICINE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 01/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 SOUTH IH 35 #E1
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-244-1978
-----------------------------------------------------
Fax | 512-244-0787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 SOUTH IH 35 #E1
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-225-6345
-----------------------------------------------------
Fax | 512-692-5205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN ASST
-----------------------------------------------------
Name | SUSAN C MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-225-6345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | J6637
-----------------------------------------------------
License Number State |
-----------------------------------------------------