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General NPI Number Information
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NPI Number | 1235130592
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Entity Type | Organization
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Legal Business Name | SOUTH AUSTIN FAMILY PRACTICE CLINIC, PLLC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 5625 EIGER RD SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78735-8982
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Country | US
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Telephone | 512-892-7076
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Fax | 239-599-2625
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone | 877-856-3774
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Fax | 239-599-2625
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN P SPENCER
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Credential | M.D.
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Telephone | 512-892-7076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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