Provider Demographics
NPI:1598781288
Name:WASSERMAN, DAVID P (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1927 LOHMANS CROSSING RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5243
Mailing Address - Country:US
Mailing Address - Phone:512-263-9188
Mailing Address - Fax:512-263-3645
Practice Address - Street 1:1927 LOHMANS CROSSING RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-5243
Practice Address - Country:US
Practice Address - Phone:512-263-9188
Practice Address - Fax:512-263-3645
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5719Medicare UPIN