MEDICARE: DR. JAMIE CARISSA OEY MD

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	208000000X	Pediatrics Physician	Q1697	TX
2	174400000X	Specialist	A53553	CA

General Provider Information

NPI Number	:	1356412084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE CARISSA OEY MD

Provider Business Mailing Address
First Line	:	4112 LINKS LN STE 102
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-3902
Country	:	US
Telephone Number	:	512-436-9455
Fax Number	:	512-436-9447

Provider Business Practice Location Address
First Line	:	4112 LINKS LN STE 102
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-3902
Country	:	US
Telephone Number	:	512-436-9455
Fax Number	:	512-436-9447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	02/01/2019

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