MEDICARE: DR. VAN O. AUSTIN 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	102L00000X	Psychoanalyst	15943-1205	UT

General Provider Information

NPI Number	:	1841466018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAN O. AUSTIN M.D.

Provider Business Mailing Address
First Line	:	9500 EAST LITTLE COTTONWOOD CANYON ROAD
Second Line	:	BOX 920013
City	:	SNOWBIRD
State	:	UT
Zip	:	84092-0013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EAST LITTLE COTTONWOOD CANYON ROAD
Second Line	:	BOX 920013
City	:	SNOWBIRD
State	:	UT
Zip	:	84092-0013
Country	:	US
Telephone Number	:	801-891-4887
Fax Number	:

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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