Provider Demographics
NPI:1093184665
Name:DEVROE, ERWIN
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:DEVROE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MASTERSON PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-3655
Mailing Address - Country:US
Mailing Address - Phone:512-636-1214
Mailing Address - Fax:
Practice Address - Street 1:102 MASTERSON PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3655
Practice Address - Country:US
Practice Address - Phone:512-636-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15952554172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver