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General NPI Number Information
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NPI Number | 1295524106
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Entity Type | Organization
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Legal Business Name | FDA MEDICAL PARTNERS PLLC
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 701 E FM 1626 STE 104
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City | AUSTIN
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State | TX
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Zip | 78748-6035
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Country | US
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Telephone | 512-989-6336
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Fax | 512-614-7007
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Provider Business Mailing Address
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Address Line | 4316 JAMES CASEY ST STE 100 BUILDING F
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City | AUSTIN
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State | TX
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Zip | 78745
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ANNELIS PETIT
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Credential |
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Telephone | 832-668-4334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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