=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902096555
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH IMSAIS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2007
-----------------------------------------------------
Last Update Date | 11/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12221 N MO PAC EXPY
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-901-4001
-----------------------------------------------------
Fax | 512-901-3901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12221 N MO PAC EXPY
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-901-4001
-----------------------------------------------------
Fax | 512-901-3901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | L5382
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------