Provider Demographics
NPI:1578625190
Name:AUSTIN FAMILY ALLERGY & ASTHMA PA
Entity Type:Organization
Organization Name:AUSTIN FAMILY ALLERGY & ASTHMA PA
Other - Org Name:AUSTIN FAMILY ALLERGY AND ASTHMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-346-7936
Mailing Address - Street 1:10801-2 NORTH MOPAC EXPWY
Mailing Address - Street 2:STE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5973
Mailing Address - Country:US
Mailing Address - Phone:512-346-7936
Mailing Address - Fax:512-388-4450
Practice Address - Street 1:10801-2 NORTH MOPAC EXPWY
Practice Address - Street 2:STE 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5973
Practice Address - Country:US
Practice Address - Phone:512-346-7936
Practice Address - Fax:512-388-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119639601Medicaid
TX00J19XOtherBCBS