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General NPI Number Information
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NPI Number | 1629383054
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Entity Type | Organization
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Legal Business Name | AUSTIN ADULT PRIMARY CARE
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 5301 W DUVAL RD SUITE A-500
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City | AUSTIN
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State | TX
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Zip | 78727-6618
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Country | US
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Telephone | 512-222-0000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 170999
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City | AUSTIN
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State | TX
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Zip | 78717-0038
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Country | US
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Telephone | 512-222-0000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARC ALBERT IBANEZ
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Credential | M.D.
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Telephone | 512-222-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | M4188
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License Number State | TX
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