Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | D7899 | TX |
N | 207Q00000X | Family Doctor | D7899 | TX |
NPI | 1225063951 |
---|---|
Provider Name | Gary R Albertson |
First Address | Austin, TX 78704-7507 |
Second Address | Austin, TX 78704-7507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 13/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128530606 | (05) | TX |
A65286 | (02) | TX |