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General NPI Number Information
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NPI Number | 1902236003
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Entity Type | Organization
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Legal Business Name | DR. AV, PLLC
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 11/30/2013
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Provider Practice Location Address
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Address Line | 210 LEE BARTON DR UNIT # 206
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City | AUSTIN
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State | TX
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Zip | 78704-1045
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Country | US
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Telephone | 210-787-6621
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Fax | 512-904-5603
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Provider Business Mailing Address
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Address Line | PO BOX 684905
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City | AUSTIN
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State | TX
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Zip | 78768-4905
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Country | US
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Telephone | 210-787-6621
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Fax | 512-904-5603
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Authorized Official
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Title or Position | HEALTHCARE PROFESSIONAL
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Name | ALEKSANDRA VIDACIC
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Credential | M.D
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Telephone | 210-787-6621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N4181
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License Number State | TX
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