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NPI Code Detail

MEDICARE: THEOPHILUS S PAINTER JR MD PA

MEDICARE: THEOPHILUS S PAINTER JR MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207K00000XAllergy & Immunology PhysicianB9692TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104000983
Entity Type Code : Organization
Provider Name (Legal Business Name) : THEOPHILUS S PAINTER JR MD PA
Provider Business Mailing Address
First Line : PO BOX 302186
Second Line :
City : AUSTIN
State : TX
Zip : 78703-0037
Country : US
Telephone Number : 512-454-5821
Fax Number : 512-260-8831
Provider Business Practice Location Address
First Line : 800 W 34TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78705-1143
Country : US
Telephone Number : 512-454-5821
Fax Number : 512-260-8831
Authorized Official
Title or Position : BILLING MGR
Name : JANE GATLIN
Credential :
Telephone Number : 512-259-9595
Provider Enumeration Date : 12/28/2007
Last Update Date : 12/28/2007

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