Provider Demographics
NPI:1558339663
Name:VAISMAN, DAN (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:VAISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N IH 35
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8300
Mailing Address - Fax:512-324-8301
Practice Address - Street 1:301 SETON PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8002
Practice Address - Country:US
Practice Address - Phone:512-324-4812
Practice Address - Fax:512-324-4728
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM0332207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172467603Medicaid
TX172467602Medicaid
TX172467604Medicaid
TX8CY383OtherBCBS
TX172467605Medicaid
TX8ET723OtherBCBS
TX172467604Medicaid
TX341197YL9XMedicare PIN
TX341197YMGJMedicare PIN
TXI26163Medicare UPIN
TXTXB136855Medicare PIN