| |
1615 Grand Avenue Pkwy 112 Pflugerville TX 78660-2059 | |
(512) 252-1505 | |
(512) 252-1506 |
Full Name | |
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Speciality | Family Medicine |
Location | 1615 Grand Avenue Pkwy, Pflugerville, Texas |
Authorized Official Name and Position | Gwendolyn Miller (PRESIDENT) |
Authorized Official Contact | 5122521505 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1615 Grand Avenue Pkwy 112 Pflugerville TX 78660-2059 Ph: (512) 252-1505 | 1615 Grand Avenue Pkwy 112 Pflugerville TX 78660-2059 Ph: (512) 252-1505 |
NPI Number | 1528076056 |
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Provider Enumeration Date | 08/03/2006 |
Last Update Date | 10/16/2007 |
Identifier | Type | State | Issuer |
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1528076056 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | H6438 (Texas) | Primary |
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