MEDICARE: DOCTORS GENERAL LABORATORY

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	291U00000X	Clinical Medical Laboratory
2	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1891796256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS GENERAL LABORATORY

Provider Business Mailing Address
First Line	:	12501 HYMEADOW DR
Second Line	:	SUITE 2B
City	:	AUSTIN
State	:	TX
Zip	:	78750-2263
Country	:	US
Telephone Number	:	512-996-0900
Fax Number	:	512-692-4596

Provider Business Practice Location Address
First Line	:	12501 HYMEADOW DR
Second Line	:	SUITE 2B
City	:	AUSTIN
State	:	TX
Zip	:	78750-2263
Country	:	US
Telephone Number	:	512-996-0900
Fax Number	:	512-692-4596

Authorized Official
Title or Position	:	C.E.O.
Name	:	MR. DAVID S WEINER
Credential	:
Telephone Number	:	512-996-0900

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/22/2013

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