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NPI Code Detail

MEDICARE: GABRIEL LEWIS PETTY PA

MEDICARE: GABRIEL LEWIS PETTY 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
1363AS0400XSurgical Physician AssistantPA06237TX
2363A00000XPhysician AssistantPA06237TX

General Provider Information

NPI Number : 1447485214
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIEL LEWIS PETTY PA
Provider Business Mailing Address
First Line : 4611 GUADALUPE ST STE 200
Second Line :
City : AUSTIN
State : TX
Zip : 78751-2928
Country : US
Telephone Number : 512-476-2830
Fax Number : 512-476-2832
Provider Business Practice Location Address
First Line : 4611 GUADALUPE ST STE 200
Second Line :
City : AUSTIN
State : TX
Zip : 78751-2928
Country : US
Telephone Number : 512-476-2830
Fax Number : 512-476-2832
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2009
Last Update Date : 06/07/2024

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Directions to “ GABRIEL LEWIS PETTY PA” Practice Location

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