Provider Demographics
NPI:1376575886
Name:AUSTIN GERIATRIC SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:AUSTIN GERIATRIC SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-856-3774
Mailing Address - Street 1:1108 LAVACA ST STE 110-320
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2172
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:12731 RESEARCH BLVD STE B200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:877-856-3774
Practice Address - Fax:512-482-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCG1751OtherMEDICARE RAILROAD
TX079678101Medicaid
TXCI5689OtherTRAVELERS/MEDICARE RAILROAD
TX00049FOtherBCBS OF TEXAS
TX079678101Medicaid