Provider Demographics
NPI:1275721839
Name:BEKANICH, AMY LOUISE SANDERS (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE SANDERS
Last Name:BEKANICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:170 DEEPWOOD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4949
Mailing Address - Country:US
Mailing Address - Phone:512-244-1444
Mailing Address - Fax:512-244-1445
Practice Address - Street 1:170 DEEPWOOD DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4944
Practice Address - Country:US
Practice Address - Phone:512-244-1444
Practice Address - Fax:512-244-1445
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6229465-1205208200000X
FL271986991208200000X
TXPO699208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery