1881778207 NPI number — WEST LAKE FAMILY PRACTICE, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881778207 NPI number — WEST LAKE FAMILY PRACTICE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST LAKE FAMILY PRACTICE, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881778207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5656 BEE CAVE RD
Provider Second Line Business Mailing Address:
E-200
Provider Business Mailing Address City Name:
WEST LAKE HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-5280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-328-8880
Provider Business Mailing Address Fax Number:
512-328-8933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5656 BEE CAVE RD
Provider Second Line Business Practice Location Address:
E-200
Provider Business Practice Location Address City Name:
WEST LAKE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-5280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-328-8880
Provider Business Practice Location Address Fax Number:
512-328-8933
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGLASS
Authorized Official First Name:
CARY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
512-328-8880

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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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