1417006586 NPI number — DR. MARTA EILEEN PUGH-WESTLYN PH,D.

Table of content: DR. MARTA EILEEN PUGH-WESTLYN PH,D. (NPI 1417006586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417006586 NPI number — DR. MARTA EILEEN PUGH-WESTLYN PH,D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUGH-WESTLYN
Provider First Name:
MARTA
Provider Middle Name:
EILEEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH,D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUGH
Provider Other First Name:
MARTA
Provider Other Middle Name:
EILEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417006586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 HARDIN LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUDA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78610-9796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-295-3796
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3103 BEE CAVE RD
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-5586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-327-9884
Provider Business Practice Location Address Fax Number:
512-327-3916
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  22938 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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