MEDICARE: FDA MEDICAL PARTNERS PLLC

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
1	2084P0301X	Brain Injury Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number	:	1295524106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FDA MEDICAL PARTNERS PLLC

Provider Business Mailing Address
First Line	:	4316 JAMES CASEY ST STE 100
Second Line	:	BUILDING F
City	:	AUSTIN
State	:	TX
Zip	:	78745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E FM 1626 STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-6035
Country	:	US
Telephone Number	:	512-989-6336
Fax Number	:	512-614-7007

Authorized Official
Title or Position	:	COO
Name	:	ANNELIS PETIT
Credential	:
Telephone Number	:	832-668-4334

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/06/2025

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