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General NPI Number Information
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NPI Number | 1497950091
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Entity Type | Organization
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Legal Business Name | DR. IMTIAZ ALAM MD, PA
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 2200 PARK BEND DR BLDG 1 STE300
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City | AUSTIN
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State | TX
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Zip | 78758-5368
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Country | US
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Telephone | 512-719-4370
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Fax | 512-719-4371
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Provider Business Mailing Address
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Address Line | 2200 PARK BEND DR BLDG 1 STE 300
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City | AUSTIN
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State | TX
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Zip | 78758-5387
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Country | US
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Telephone | 512-719-4370
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Fax | 512-719-4371
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ELIZABETH ASHTON
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Credential |
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Telephone | 512-719-4370
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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 | K3057
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License Number State | TX
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