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General NPI Number Information
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NPI Number | 1982621520
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Entity Type | Individual
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Provider Name | ANNA HA-LINH PHUONG VU-WALLACE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 4107 MEDICAL PKWY #210
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City | AUSTIN
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State | TX
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Zip | 78756-3735
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Country | US
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Telephone | 512-323-5362
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Fax | 512-335-7168
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Provider Business Mailing Address
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Address Line | PO BOX 13442
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City | AUSTIN
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State | TX
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Zip | 78711-3442
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Country | US
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Telephone | 512-323-5465
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | L3173
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | L3173
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License Number State | TX
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