Provider Demographics
NPI:1497024905
Name:MENS WELLNESS CENTER ONE LLC
Entity Type:Organization
Organization Name:MENS WELLNESS CENTER ONE LLC
Other - Org Name:MENS WELLNESS CENTER OF AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-454-9700
Mailing Address - Street 1:3724 JEFFERSON ST
Mailing Address - Street 2:STE 112
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6225
Mailing Address - Country:US
Mailing Address - Phone:512-454-9700
Mailing Address - Fax:512-407-9511
Practice Address - Street 1:3724 JEFFERSON ST
Practice Address - Street 2:STE 112
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6225
Practice Address - Country:US
Practice Address - Phone:512-454-9700
Practice Address - Fax:512-407-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8227207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty