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General NPI Number Information
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NPI Number | 1699878801
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Entity Type | Organization
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Legal Business Name | GREATER AUSTIN NEUROLOGY CLINIC PA
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 13915 N MO PAC EXPY SUITE 302
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City | AUSTIN
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State | TX
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Zip | 78728-6517
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Country | US
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Telephone | 512-228-3800
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Fax | 512-228-3801
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Provider Business Mailing Address
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Address Line | 13915 N MO PAC EXPY SUITE 302
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City | AUSTIN
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State | TX
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Zip | 78728-6517
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Country | US
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Telephone | 512-228-3800
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Fax | 512-228-3801
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MUHAMMAD MUNIR
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Credential | MD
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Telephone | 512-228-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | L6538
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | L6538
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License Number State | TX
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