Provider Demographics
NPI:1174547509
Name:OSWALT, JOHN D (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:OSWALT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4010
Mailing Address - Country:US
Mailing Address - Phone:512-459-8753
Mailing Address - Fax:512-483-6807
Practice Address - Street 1:1010 W 40TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4010
Practice Address - Country:US
Practice Address - Phone:512-459-8753
Practice Address - Fax:512-483-6807
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8375208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117731301Medicaid
TX85002XMedicare ID - Type UnspecifiedSAN ANGELO PROVIDER NO.
TXB25318Medicare UPIN
TX824097Medicare ID - Type UnspecifiedAUSTIN PROVIDER NUMBER