Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | F2161 | TX |
NPI | 1003898719 |
---|---|
Provider Name | Dr. Michael Joseph Austin |
First Address | Friendswood, TX 77549-1167 |
Second Address | Friendswood, TX 77546-2012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 18/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1150286-01 | (05) | TX |
C13010 | (02) | TX |