Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E2727 | TX |
NPI | 1003852179 |
---|---|
Provider Name | Dr. Albert Edward Meisenbach III |
First Address | Austin, TX 78701-1031 |
Second Address | Austin, TX 78712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 10/11/2011 |