MEDICARE: DR. ASHWIN GOWDA M.D.

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	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	L5347	TX
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	L5347	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AX780	OTHER	TX	BCBS INDIVIDUAL #

General Provider Information

NPI Number	:	1669447397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHWIN GOWDA M.D.

Provider Business Mailing Address
First Line	:	1221 W BEN WHITE BLVD
Second Line	:	SUITE A-100
City	:	AUSTIN
State	:	TX
Zip	:	78704-7192
Country	:	US
Telephone Number	:	512-440-5757
Fax Number	:	512-440-5858

Provider Business Practice Location Address
First Line	:	1221 W BEN WHITE BLVD
Second Line	:	SUITE A-100
City	:	AUSTIN
State	:	TX
Zip	:	78704-7192
Country	:	US
Telephone Number	:	512-440-5757
Fax Number	:	512-440-5858

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	09/06/2013

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